Individual provider Active NPI

Timothy Deaconson, MD

  • Surgery Physician
  • Mankato, MN
National Provider Identifier
1679559355
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
47404 Issued in MN
Practice address
1025 Marsh St
Mankato, MN 56001-4752
Phone
(507) 625-4031
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 47404 MN Primary

Addresses

Primary practice location

1025 Marsh St
Mankato, MN 56001-4752

Mailing address

1015 Marsh St
Mankato, MN 56001-5294
Phone (507) 389-4700

Other practice location 1

2190 Lynn Rd Ste 300
Thousand Oaks, CA 91360-8024
Phone (805) 600-4001

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tdeaconson92108@excellian.direct.allina.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050105000595 MN Practitioner - General Surgery 6507759602 Reassigns benefits to 4 organizations
I20210914001035 CA Practitioner - General Surgery 6507759602 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Texas Southwestern Medical School at Dallas, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acute Care Surgery Medical Group IncGroup PAC ID 7214006816, 205 clinicians

Practice addresses (Care Compare)

215 W Janss Rd
Thousand Oaks, CA 91360-1847
Phone (805) 497-2727

Hospital & facility affiliations

  • Los Robles Hospital & Medical Center Hospital, Thousand Oaks, CA, CCN 050549
  • Desert Regional Medical Center Hospital, Palm Springs, CA, CCN 050243
  • Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236
  • Hi-Desert Medical Center Hospital, Joshua Tree, CA, CCN 050279

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Coronary artery bypass graft (CABG)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux12
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Feb 17, 2019 Accepting new patients
Fairview Express Care CurrentSince Feb 17, 2019 Accepting new patients
Group Health, Inc. Current Accepting new patients
Life Medical Practitioners CurrentSince Jun 1, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics Current Accepting new patients
Jaspreet Somal M.D., a.P.C. CurrentSince Jun 1, 2024 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery CurrentSince Sep 21, 2021 Accepting new patients
Fairview Clinics CurrentSince Nov 17, 2014 Accepting new patients
Fairview Clinics CurrentSince Nov 17, 2014 Accepting new patients
Fairview Health Services Current Accepting new patients
Surgical Affiliates of California Surgery CurrentSince Jun 1, 2025 Accepting new patients
Group Health, Inc. CurrentSince Mar 1, 2020 Accepting new patients

Locations

2801 Atlantic Ave
Long Beach, CA 90806
Phone (310) 933-2000

2865 Atlantic Ave
Ste 104
Long Beach, CA 90806
Phone (562) 933-1820

27700 Medical Center Rd
Mission Viejo, CA 92691
Phone (949) 364-7744

215 W Janss Rd
Thousand Oaks, CA 91360
Phone (805) 379-5435

2190 Lynn Rd
Ste 300
Thousand Oaks, CA 91360
Phone (805) 242-4884

2621 Greenhaven Rd
Anoka, MN 55303
Phone (763) 587-4400

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

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

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

Interoperability endpoints

  • Direct secure messaging: tdeaconson714029@direct.memorialcare.org
  • Direct secure messaging: tdeaconson92108@excellian.direct.allina.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1679559355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015294",
            "telephone_number": "507-389-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2190 Lynn Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913608024",
            "country_code": "US",
            "telephone_number": "805-600-4001",
            "fax_number": "805-309-4798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEACONSON",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "47404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdeaconson92108@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "4194 Lexington Ave N",
            "city": "Shoreview",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551266106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.