Timothy Richard Fresonke, PA-C
Individual provider Active NPI Physician Assistant · Perham, MN
NPI 1548945397 · NPPES record last updated Jun 25, 2023
Key facts
- NPI
- 1548945397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 14526 (MN)
- Practice address
- 1000 Coney St W
Perham, MN 56573-2102 - Phone
- (218) 347-1400
- NPI assigned
- Jun 20, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of North Dakota School of Medicine, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Perham Hospital District
Practice addresses (Care Compare)
1000 Coney St W
Perham, MN 56573-2102
Phone (218) 347-1656
1000 Coney W St
Perham, MN 56573-2102
105 Otter Dr
Ottertail, MN 56571-7040
Phone (218) 367-6111
Hospital & facility affiliations
- Perham Health
- Sanford Medical Center Fargo
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.39 of 100
- Quality
- 91.62
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 66.36
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230728002085 | MN | Practitioner - Physician Assistant | 8628439205 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14526 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perham Hospital District | Current |
Accepting new patients |
Locations
105 Otter Dr
Ottertail, MN 56571
Phone (218) 367-6111
1000 Coney St W
Perham, MN 56573
Phone (218) 347-1200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14526 | MN | Yes |
Addresses
Primary practice location
1000 Coney St W
Perham, MN 56573-2102
Mailing address
1000 Coney St W
Perham, MN 56573-2102
Phone (218) 347-1400
Other providers in Perham, MN
- East Ottertail Pharmacy
- Sadie Mae Ellenberg
- Empowering Kids Perham
- Daisy Ewing
- Jessi Lee Fish
- Erin Carey Friedsam
- Mariah Geoghegan
- Sarah N Gillespie
- Brett Jon Glawe
- Jennifer Gleason
All providers in Perham, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.