Individual provider Active NPI

Timothy J Mahoney, MD

  • Surgery Physician
  • Fargo, ND
National Provider Identifier
1689608192
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
3622 Issued in ND
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

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
120231OtherNDUCARE #
1700559OtherNDMEDICA #
20698OtherNDNDBS #
2164OtherNDNDBS #
844548OtherNDAMERICA'S PPO/ARAZ #
13390MedicaidND
ND20017469OtherNDLHS #
1700509OtherNDMEDICA #
6508OtherNDSIOUX VALLEY #
DA9011008232OtherNDPREFERRED ONE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 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
I20071205000061 ND Practitioner - General SurgeryPractitioner - Family Practice 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 SurgeryAlso: Family Practice
Education
Tufts University School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Vein Clinics PCGroup PAC ID 9638356876, 7 clinicians
Family Health Care CenterGroup PAC ID 1658283650, 25 clinicians

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

ProcedureNumber of procedures
Varicose vein removal48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24007MNMDSurgery Physician
3622NDMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Care Center Current Accepting new patients
Lake Region Healthcare Corporation CurrentSince Apr 1, 2020 Accepting new patients
Lake Region Healthcare Corporation CurrentSince Nov 1, 2014 Accepting new patients
Lake Region Healthcare Corporation CurrentSince Nov 1, 2014 Accepting new patients
Family Health Care Center CurrentSince Dec 15, 2023 Accepting new patients
Lake Region Healthcare Corporation Current Accepting new patients
Internal Medicine Associates Inc CurrentSince Sep 16, 2014 Accepting new patients
Physicians Vein Clinics, PC Family Medicine CurrentSince Dec 1, 2023 Accepting new patients
Dakota Clinic, LTD. PastSince Jan 16, 2008 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

  • FHIR API: https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/
  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.