Active NPI
Timothy J Mahoney, MD
- Surgery Physician
- Fargo, ND
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 3622
- Practice address
- 1707 Gold Dr S Ste 101
Fargo, ND 58103-6413 - Phone
- (701) 280-2033
- Fax
- (701) 232-5578
- NPI assigned
- Jul 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3622 | ND | |
| Surgery Physician | 208600000X | 24007 | MN | |
| General Practice Physician | 208D00000X | 3622 | ND | |
| Surgery Physician | 208600000X | 3622 | ND | Primary |
Addresses
Primary practice location
1707 Gold Dr S Ste 101
Fargo, ND 58103-6413
Mailing address
1707 Gold Dr S Ste 101
Fargo, ND 58103-6413
Phone (701) 280-2033
Other practice location 1
301 Np Ave N
Fargo, ND 58102-4835
Phone (701) 271-3344
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120231 | Other | ND | UCARE # |
| 1700559 | Other | ND | MEDICA # |
| 20698 | Other | ND | NDBS # |
| 2164 | Other | ND | NDBS # |
| 844548 | Other | ND | AMERICA'S PPO/ARAZ # |
| 13390 | Medicaid | ND | |
| ND20017469 | Other | ND | LHS # |
| 1700509 | Other | ND | MEDICA # |
| 6508 | Other | ND | SIOUX VALLEY # |
| DA9011008232 | Other | ND | PREFERRED ONE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND, MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071205000061 | ND | Practitioner - General Surgery | 0840195822 | Reassigns benefits to 3 organizations |
| I20081013000116 | MN | Practitioner - General Surgery | 0840195822 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Tufts University School of Medicine, 1974
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physicians Vein Clinics PCFamily Health Care Center
Practice addresses (Care Compare)
1650 45TH St S
Suite 114
Fargo, ND 58103-3247
Phone (888) 782-8346
301 NP Ave N
Fargo, ND 58102-4835
Phone (701) 271-3344
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Varicose vein removal | 48 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24007 | MN | MD | Surgery Physician |
| 3622 | ND | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Care Center | Current | Accepting new patients | |
| Lake Region Healthcare Corporation | Current | Accepting new patients | |
| Lake Region Healthcare Corporation | Current | Accepting new patients | |
| Lake Region Healthcare Corporation | Current | Accepting new patients | |
| Family Health Care Center | Current | Accepting new patients | |
| Lake Region Healthcare Corporation | Current | Accepting new patients | |
| Internal Medicine Associates Inc | Current | Accepting new patients | |
| Physicians Vein Clinics, PC | Family Medicine | Current | Accepting new patients |
| Dakota Clinic, LTD. | Past | Accepting new patients |
Locations
1411 Highway 79 E
Elbow Lake, MN 56531
Phone (218) 685-7300
649 State St NW
Evansville, MN 56326
Phone (218) 948-2040
712 S Cascade St
Fergus Falls, MN 56537
301 Np Ave N
Fargo, ND 58102
1650 45th St S
Ste 114
Fargo, ND 58103
Phone (800) 597-2095
4025 9th Ave S
Fargo, ND 58103
Phone (701) 551-2446
4450 31st Ave S
Ste 102
Fargo, ND 58104
Phone (701) 280-2033
1707 Gold Dr S
Ste 101
Fargo, ND 58103
Phone (701) 280-2033
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/
- timothy.mahoney.1@28859.direct.athenahealth.com
Organizations & group practices 10
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.
-
- Federally Qualified Health Center (FQHC)
- Moorhead, MN
- NPI 1992559645
-
- Federally Qualified Health Center (FQHC)
- Lamoure, ND
- NPI 1689350415
-
- General Acute Care Hospital
- Fergus Falls, MN
- NPI 1093713372
-
- Chiropractor
- Fergus Falls, MN
- NPI 1265148480
-
- Durable Medical Equipment & Medical Supplies
- Fergus Falls, MN
- NPI 1942191119
-
- Clinical Medical Laboratory
- Fargo, ND
- NPI 1740220391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1689608192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 GOLD DR S STE 101",
"city": "FARGO",
"state": "ND",
"postal_code": "581036413",
"telephone_number": "701-280-2033",
"fax_number": "701-232-5578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1707 GOLD DR S STE 101",
"city": "FARGO",
"state": "ND",
"postal_code": "581036413",
"telephone_number": "701-280-2033",
"fax_number": "701-232-5578"
}
],
"practiceLocations": [
{
"address_1": "301 Np Ave N",
"address_purpose": "LOCATION",
"city": "Fargo",
"state": "ND",
"postal_code": "581024835",
"country_code": "US",
"telephone_number": "701-271-3344",
"fax_number": "701-271-3347",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAHONEY",
"first_name": "TIMOTHY",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "3622",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "24007",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "ND",
"license": "3622",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ND",
"license": "3622",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE #",
"identifier": "120231",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "1700559",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "20698",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "2164",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO/ARAZ #",
"identifier": "844548",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13390",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LHS #",
"identifier": "ND20017469",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "1700509",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIOUX VALLEY #",
"identifier": "6508",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE #",
"identifier": "DA9011008232",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.