Active NPI
Bryan T Wood, MD
- Surgery Physician
- Mankato, MN
National Provider Identifier
1659350650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 43467
- Practice address
- 1230 E Main St
Mankato Clinic @ Main Street
Mankato, MN 56001-5066 - 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 43467 | MN | Primary |
Addresses
Primary practice location
1230 E Main St
Mankato Clinic @ Main Street
Mankato, MN 56001-5066
Mailing address
1230 E Main St
PO Box 8674
Mankato, MN 56001-5066
Phone (507) 625-1811
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700938 | Other | MEDICA MN | |
| HP38121 | Other | HEALTH PARTNERS MN | |
| 020054167 | Other | RR MEDICARE | |
| 171077 | Other | UCARE MN | |
| 2149398 | Other | AMERICAS PPO MN | |
| 0593053 | Medicaid | IA | |
| 410849339 56001 C198 | Other | CHAMPUS | |
| NA2951034555 | Other | PREFERRED ONE MN | |
| 027L5WO | Other | BCBS MN | |
| 988153100 | Medicaid | MN |
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
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": "1314921600000",
"number": "1659350650",
"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": "560015066",
"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": "560015066",
"telephone_number": "507-625-1811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "BRYAN",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2011-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "43467",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA MN",
"identifier": "1700938",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS MN",
"identifier": "HP38121",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "020054167",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE MN",
"identifier": "171077",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAS PPO MN",
"identifier": "2149398",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0593053",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "410849339 56001 C198",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE MN",
"identifier": "NA2951034555",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN",
"identifier": "027L5WO",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "988153100",
"state": "MN"
}
],
"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 Sep 2, 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.