NPIMap

Individual provider Active NPI

Brant Nicholas Hacker, M.D.

  • Family Medicine Physician
  • Madison, MN
National Provider Identifier
1679633655
Registry record updated Aug 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
46741 Issued in MN
Practice address
900 2ND Ave
Madison, MN 56256-1006
Phone
(320) 598-7551
Fax
(320) 598-3798
NPI assigned
Dec 11, 2006
Last updated
Aug 16, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 46741 MN Primary

Addresses

Primary practice location

900 2ND Ave
Madison, MN 56256-1006

Mailing address

900 2ND Ave
Madison, MN 56256-1006
Phone (320) 598-7551

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
I20041221000544 MN Practitioner - General PracticePractitioner - Family Practice 6608834718 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of Minnesota Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madison Healthcare ServicesGroup PAC ID 9638080187, 29 clinicians
Lac Qui Parle Clinic of Madison IncGroup PAC ID 5799727707, 15 clinicians

Practice addresses (Care Compare)

820 3Rd Ave
Madison, MN 56256-1014
Phone 32059875517551

900 2ND Ave
Madison, MN 56256-1006
Phone 32059875517158

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lac Qui Parle Clinic of Madison Inc CurrentSince Mar 15, 2018 Accepting new patients
Madison Healthcare Services CurrentSince Jul 1, 2016 Accepting new patients
Madison Healthcare Services Past Accepting new patients

Locations

820 3rd Ave
Madison, MN 56256
Phone (320) 598-3552

900 2nd Ave
Madison, MN 56256
Phone (320) 598-7536

Interoperability endpoints

  • Direct secure messaging: bhacker323221@direct.centracare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Madison Lutheran HomeMadison, MN, CCN 245382 Skilled nursing facility W-2 Managing Employee Sep 19, 2005

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 6

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502841600000",
    "number": "1679633655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 2ND AVE",
            "city": "MADISON",
            "state": "MN",
            "postal_code": "562561006",
            "telephone_number": "320-598-7551",
            "fax_number": "320-598-3798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 2ND AVE",
            "city": "MADISON",
            "state": "MN",
            "postal_code": "562561006",
            "telephone_number": "320-598-7551",
            "fax_number": "320-598-3798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKER",
        "first_name": "BRANT",
        "middle_name": "NICHOLAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2017-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "46741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MN

Sources for this page

Verify at the official NPI Registry.