Alex Jacob Mangan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

81984 Issued in MN

Practice address

424 W State Highway 5
Waconia, MN 55387-1795

Phone

(952) 442-4461

Fax

(952) 442-1547

NPI assigned

May 18, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
• Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alex.mangan.1@21094.direct.athenahealth.com

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.

• Lakeview Clinic, LTD.

  • Multi-Specialty Clinic/Center
  • Waconia, MN
  • NPI 1669599981
  NPD

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

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation
• Proctor Community Hospital

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1033116876
  Care Compare affiliation
• Proctor Community Hospital

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1134826894
  Care Compare affiliation

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

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1669163614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871795",
            "telephone_number": "952-442-4461",
            "fax_number": "952-442-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871795",
            "telephone_number": "952-442-4461",
            "fax_number": "952-442-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "ALEX",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-18",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "81984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenthun Beck Pharmacy, Inc
• Mackenthun Supermarkets, Inc.
• Yalda Mahinfalah
• Kim A Maletta Shibley, MD
• Prasun Mandal, DO
• Nicole Marcouiller, MSW, LICSW
• Daniel Joseph Marek, M.D.
• Alecia Marfio, DC
• Jeffrey Duane Martin, CRNA
• Birdie Margaret Martinka-Breiner, LICSW

• Family Medicine Physician in Waconia, MN
• Providers in Waconia, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.