NPIMap

Organization Active NPI

Ophthalmology Associates of Mankato PA

  • Ophthalmology Physician
  • Mankato, MN
National Provider Identifier
1801892237
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
D48658 Issued in MN
Legal business name
OPHTHALMOLOGY ASSOCIATES OF MANKATO PA
Practice address
1630 Adams St
Mankato, MN 56001
Phone
(507) 345-6151
Fax
(507) 625-1096
NPI assigned
Jun 21, 2005
Last updated
Jan 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Authorized official

Name
Sara Emich
Title
Administrator
Phone
(507) 345-6151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X D48658 MN Primary

Addresses

Primary practice location

1630 Adams St
Mankato, MN 56001

Mailing address

1630 Adams St
Mankato, MN 56001-4801
Phone (507) 345-6151

Other identifiers 1

IdentifierTypeStateIssuer
590312200MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050707000724 MN Part B Supplier - Clinic/Group Practice 8224074620 Receives reassigned benefits from 6 practitioners
Practice locations: Mankato, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ophthalmology Associates of Mankato PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1630 Adams St
Ste A
Mankato, MN 56001
Phone (507) 345-6151

Interoperability endpoints

  • Direct secure messaging: ebirkholz@oaom.intellechartdirect.net
  • Direct secure messaging: ncarpenter@oaom.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1801892237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 ADAMS ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014801",
            "telephone_number": "507-345-6151",
            "fax_number": "507-625-1096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 ADAMS ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-345-6151",
            "fax_number": "507-625-1096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY ASSOCIATES OF MANKATO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "EMICH",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "507-345-6151"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "D48658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590312200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.