Individual provider Active NPI

Jennifer Myaeng, D.O.

  • Pediatrics Physician
  • Mankato, MN
National Provider Identifier
1467890798
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
DOS1667 Issued in HI
Practice address
1025 Marsh St
Mankato, MN 56001-4752
Phone
(507) 594-4700
NPI assigned
Jun 9, 2013
Last updated
Sep 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X DOS1667 HI Primary
General Practice Physician 208D00000X DOS1667 HI

Addresses

Primary practice location

1025 Marsh St
Mankato, MN 56001-4752

Mailing address

1025 Marsh St
Mankato, MN 56001-4752

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20240828003287 IA Practitioner - Pediatric Medicine 1951711852 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DOS1667HIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Iowa Hospital Corporation CurrentSince Sep 24, 2024 Accepting new patients
Trinity Regional Medical Center CurrentSince Sep 24, 2024 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Central Iowa Hospital Corporation Current Accepting new patients
Central Iowa Hospital Corporation Pediatrics CurrentSince Sep 24, 2024 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Past Accepting new patients
Central Iowa Hospital Corporation Past Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Past Accepting new patients
Central Iowa Hospital Corporation Past Accepting new patients

Locations

1200 Pleasant St
Des Moines, IA 50309
Phone (515) 241-5926

802 Kenyon Rd
Fort Dodge, IA 50501
Phone (515) 574-6565

1660 60th St
West Des Moines, IA 50266
Phone (515) 241-2250

Interoperability endpoints

  • Direct secure messaging: jmyaeng1110597@direct.unitypoint.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1370736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1467890798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-594-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYAENG",
        "first_name": "JENNIFER",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-09",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "HI",
            "license": "DOS1667",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "HI",
            "license": "DOS1667",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.