Jack Leon-Max Mutnick, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

48180 Issued in MN

Practice address

3939 W 69TH St Ste a
Edina, MN 55435-2001

Phone

(612) 930-8462

Fax

(800) 785-5608

NPI assigned

May 27, 2006

Last updated

Dec 11, 2024By 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 2

Addresses

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

Specialty

Allergy/Immunology

Education

University of Nevada School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary ENT, L.L.C.Group PAC ID 1658754015, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Primary ENT, L.L.C.

  dba Primary ENT

  • Otolaryngology/Facial Plastic Surgery Physician
  • Savage, MN
  • NPI 1386374593
  Medicare reassignment Care Compare group NPD
• Allergy and Asthma Associates, LLC

  • Clinic/Center
  • Saint Cloud, MN
  • NPI 1710667449
  NPD Authorized official
• Mutnick Allergy & Asthma, L.L.C.

  • Allergy Physician
  • Minneapolis, MN
  • NPI 1538866231
  Authorized official Same address or phone

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1487601316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 MOLINA ST",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553795444",
            "telephone_number": "714-296-6777",
            "fax_number": "800-785-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 W 69TH ST STE A",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352001",
            "telephone_number": "612-930-8462",
            "fax_number": "800-785-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTNICK",
        "first_name": "JACK",
        "middle_name": "LEON-MAX",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MN",
            "license": "48180",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "48180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Cyril Murphy, LADC, LPCC
• Matthew Campbell Murray, L.AC.
• Brianna A Murugesan, DO
• Ayan Mohamed Musse, DNP
• Raani Musse
• Cheryl Lynn Mutschler, LAC
• Alexandra Mary Tamsin Myhill-Jones
• Virgil M Mylan, D.D.S.
• Jennifer Lynn Naas, D.C.
• Yamit Frances Nachmias, DC

• Internal Medicine Physician in Edina, MN
• Providers in Edina, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 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; Order and Referring.
• 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.