Active NPI
Mark A Myers, MD
- Diagnostic Radiology Physician
- Mankato, MN
National Provider Identifier
1497734495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 45804
- Practice address
- 1230 E Main St
Mankato Clinic @ Main Street
Mankato, MN 56002-8674 - Phone
- (507) 625-1811
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 45804 | MN | Primary |
Addresses
Primary practice location
1230 E Main St
Mankato Clinic @ Main Street
Mankato, MN 56002-8674
Mailing address
1230 E Main St
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 097L1MY | Other | MN | BCBS |
| 41084933956001C202 | Other | CHAMPUS | |
| HP37918 | Other | MN | HEALTH PARTNERS |
| NA2951022862 | Other | MN | PREFERRED ONE |
| 1602454 | Other | MN | MEDICA |
| 171361 | Other | MN | UCARE |
| 2227442 | Other | MN | AMERICAS PPO |
| 996422300 | Medicaid | MN | |
| P00039431 | Other | RR MEDICARE | |
| 0568519 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45804 | MN | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1497734495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 E MAIN ST",
"address_2": "PO BOX 8674",
"city": "MANKATO",
"state": "MN",
"postal_code": "560028674",
"telephone_number": "507-625-1811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1230 E MAIN ST",
"address_2": "MANKATO CLINIC @ MAIN STREET",
"city": "MANKATO",
"state": "MN",
"postal_code": "560028674",
"telephone_number": "507-625-1811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "MARK",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MN",
"license": "45804",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "097L1MY",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "41084933956001C202",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP37918",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "NA2951022862",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "1602454",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "171361",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAS PPO",
"identifier": "2227442",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "996422300",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00039431",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0568519",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}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 Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.