NPIMap

Individual provider Active NPI

Benjamin Lars Mitlyng, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Minneapolis, MN
National Provider Identifier
1548434210
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
420 Delaware St SE
A539 Mayo
Minneapolis, MN 55455-0341
Phone
(612) 626-2636
NPI assigned
Apr 14, 2008
Last updated
Apr 14, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

420 Delaware St SE
A539 Mayo
Minneapolis, MN 55455-0341

Mailing address

420 Delaware St SE
MMC 36
Minneapolis, MN 55455-0341
Phone (612) 626-2636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100903000322 MN Practitioner - Gastroenterology 3577687177 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Minnesota Medical School, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

15700 37TH Ave N
Suite 300
Plymouth, MN 55446-3661
Phone (612) 871-1145

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy44
Upper gastrointestinal (GI) endoscopy for acid reflux173

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mngi Digestive Health, P.a. CurrentSince Jul 1, 2011 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Sep 1, 2010 Accepting new patients

Locations

420 Delaware St SE
#36
Minneapolis, MN 55455
Phone (612) 273-8425

420 Delaware St SE
#A539
Minneapolis, MN 55455
Phone (612) 626-2636

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

15700 37th Ave N
Ste 300
Plymouth, MN 55446
Phone (612) 870-5555

Interoperability endpoints

  • Direct secure messaging: benjamin.mitlyngmd.p1@direct.mngastro.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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.

Hospital & facility affiliations 39

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1548434210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "MMC 36",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "A539 MAYO",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITLYNG",
        "first_name": "BENJAMIN",
        "middle_name": "LARS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.