NPIMap

Individual provider Active NPI

Theodore J Hanson, MD

  • Diagnostic Radiology Physician
  • Austin, MN
National Provider Identifier
1417211483
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
56567 Issued in MN
Practice address
1000 1St Dr NW
Austin, MN 55912-2941
Phone
(507) 433-7351
NPI assigned
Jun 25, 2012
Last updated
Jul 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 68648-20 WI
Diagnostic Radiology Physician 2085R0202X 56567 MN Primary

Addresses

Primary practice location

1000 1St Dr NW
Austin, MN 55912-2941

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Other practice location 1

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidIA
ENROLLEDMedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address thanson108244@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130806000839 MN Practitioner - Diagnostic Radiology 1254577240 Reassigns benefits to 8 organizations
I20210720002617 WI Practitioner - Diagnostic Radiology 1254577240 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Health System-Southwest Wisconsin Region IncGroup PAC ID 0345152443, shared by 9 NPIs, 539 clinicians

Practice addresses (Care Compare)

1303 S Main St
Holmen, WI 54636-8927
Phone (608) 526-3351

191 Theater Rd
Onalaska, WI 54650-8679
Phone (608) 392-5000

700 Buffalo St
Mondovi, WI 54755-1371
Phone (715) 926-4858

700 W Ave S
La Crosse, WI 54601-4783
Phone (608) 785-0940

800 E Blackhawk Ave
Prairie Du Chien, WI 53821-1698
Phone (608) 326-0808

800 W Ave S
La Crosse, WI 54601-8806
Phone (608) 785-0940

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
68648-20WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-St James CurrentSince Feb 26, 2018 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jul 4, 2021 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Lake City CurrentSince Jul 1, 2017 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Mar 11, 2018 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Aug 16, 2021 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Fairmont CurrentSince Sep 1, 2017 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Jul 1, 2017 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Mar 11, 2018 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Sep 1, 2017 Accepting new patients
Mayo Clinic Health System-Lake City Current Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Apr 8, 2018 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Jul 1, 2017 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Apr 8, 2018 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

1000 1st Dr NW
Austin, MN 55912
Phone (507) 433-7351

32021 County 24 Blvd
Cannon Falls, MN 55009
Phone (507) 263-6000

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

300 State Ave
Faribault, MN 55021
Phone (507) 333-3300

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

2200 NW 26th St
Owatonna, MN 55060
Phone (507) 451-1120

701 Hewitt Blvd
Red Wing, MN 55066
Phone (507) 377-6285

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

825 Mankato Ave
Winona, MN 55987
Phone (507) 454-4925

1501 Thompson St
Bloomer, WI 54724
Phone (715) 568-2000

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

530 W Cairns St
Ellsworth, WI 54011
Phone (715) 273-5061

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

2321 Stout Rd
Menomonie, WI 54751
Phone (715) 235-5531

13025 8th St
Osseo, WI 54758
Phone (715) 597-2575

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

Organizations & group practices 22

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.

View all 22

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1417211483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 1ST DR NW",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559122941",
            "telephone_number": "507-433-7351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSON",
        "first_name": "THEODORE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "68648-20",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "56567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thanson108244@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1000 1st Dr NW",
            "city": "Austin",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559122941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Austin, MN

Sources for this page

Verify at the official NPI Registry.