Timothy John Anderson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

30239 Issued in MN

Practice address

501 E Nicollet Blvd
Suite 200
Burnsville, MN 55337-6732

Phone

(952) 898-5900

Fax

(952) 898-5914

NPI assigned

Aug 14, 2006

Last updated

Sep 8, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/1846cf9e-8006-4277-b72f-3cbbe8a8f5ca/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southdale Pediatric Associates, LTD

  • Multi-Specialty Clinic/Center
  • Edina, MN
  • NPI 1245305895
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1245243138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 PARKLAWN AVE",
            "address_2": "SUITE 120",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355655",
            "telephone_number": "952-831-1944",
            "fax_number": "952-278-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E NICOLLET BLVD",
            "address_2": "SUITE 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376732",
            "telephone_number": "952-898-5900",
            "fax_number": "952-898-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "30239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "416282000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "FP9020802010",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1211637",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "13183AN",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madeline Anderson
• Matt Alan Anderson, OTR
• Megan Neely Anderson, SLP
• Tara E Anderson, ATC
• Thomas Alan Anderson, DC
• Andrew J Will MD PA (Twin Cities Pain Clinic)
• Janee Marie Anez, LICSW
• Angel Academy Inc
• Angel Academy Inc.
• Lauren Angrimson

• Pediatrics Physician in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.