Timothy M Scanlan, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

20245 Issued in MN

Practice address

4767 Dahlia Way N
Hugo, MN 55038-6060

Phone

(651) 493-4856

NPI assigned

Sep 27, 2005

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Addiction Specialists of Kansas

  • Clinical Medical Laboratory
  • Wichita, KS
  • NPI 1821271941
  NPD (past)
• Addiction Specialists of Kansas, Inc,

  • Addiction (Substance Use Disorder) Counselor
  • Wichita, KS
  • NPI 1023101656
  NPD (past)
• Via Christi Hospitals Wichita, Inc

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1376539502
  NPD (past)

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1528054301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4767 DAHLIA WAY N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550386060",
            "telephone_number": "651-493-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4767 DAHLIA WAY N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550386060",
            "telephone_number": "651-493-4856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLAN",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "KS",
            "license": "17663",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MN",
            "license": "20245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Ruzicka
• Leann Kay Sagerer, OTR
• Madeline Sakry
• Adeline Sampson, MA
• Jennifer Esther Sargent, P.T.
• Rebecca Anne Schultz
• Veronica Lynn Senkyr, M.A., LMFT
• Johnny Servin
• Madison Shannon
• Lindsey Ann Shiltz

• All providers in Hugo, MN
• Addiction Medicine (Family Medicine) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.