Individual provider Active NPI

Colleen Vitzthum, AU.D.

  • Audiologist
  • Mankato, MN
National Provider Identifier
1477921500
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
9557 Issued in MN
Practice address
1421 Premier Dr
Mankato, MN 56001-6076
Phone
(507) 385-4025
NPI assigned
Sep 6, 2015
Last updated
Jul 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 9557 MN Primary

Addresses

Primary practice location

1421 Premier Dr
Mankato, MN 56001-6076

Mailing address

1421 Premier Dr
Mankato, MN 56001-6076
Phone (507) 385-4025

Other names 1

  • Colleen Ireland Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150923002924 MN Practitioner - Qualified Audiologist 8123335197 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mankato Clinic LTDGroup PAC ID 5597677955, 243 clinicians

Practice addresses (Care Compare)

1230 Main St E
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9557MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Nov 1, 2017 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Aug 25, 2015 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Aug 25, 2015 Accepting new patients
Mankato Clinic LTD CurrentSince Jun 1, 2024 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Nov 1, 2017 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Current Accepting new patients

Locations

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

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

1421 Premier Dr
Mankato, MN 56001
Phone (507) 385-4000

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

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

Interoperability endpoints

  • Direct secure messaging: colleenvitzthum@mklt.allscriptsdirect.net

Organizations & group practices 6

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": "1441497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1477921500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 PREMIER DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016076",
            "telephone_number": "507-385-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 PREMIER DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016076",
            "telephone_number": "507-385-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITZTHUM",
        "first_name": "COLLEEN",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-06",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "9557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "IRELAND",
            "credential": "AU.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.