Active NPI
Michael G Nicklawsky, MD
- Family Medicine Physician
- Willmar, MN
National Provider Identifier
1841266152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36966
- Practice address
- 101 Willmar Ave SW
Willmar, MN 56201 - Phone
- (320) 231-5000
- Fax
- (320) 231-5067
- NPI assigned
- Feb 27, 2006
- Last updated
- Mar 29, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36966 | MN | Primary |
Addresses
Primary practice location
101 Willmar Ave SW
Willmar, MN 56201
Mailing address
101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036217400 | Medicaid | MN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mnicklawsky29793@direct.centracare.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Cincinnati College of Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
101 Willmar Ave SW
Willmar, MN 56201-3556
Phone (320) 231-5000
600 Peterson Pkwy
New London, MN 56273-7823
Phone (320) 354-2222
Hospital & facility affiliations
- Ecumen Home Care and Hospice - Litchfield
- Centracare Hospice
- Centracare- Rice Memorial Hospital
- Bethesda
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Clinic Southwest LLC | Current | Accepting new patients | |
| Centracare Clinic Southwest LLC | Current | Accepting new patients |
Locations
600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Willmar, MN
- NPI 1174106264
-
- Durable Medical Equipment & Medical Supplies
- Willmar, MN
- NPI 1912664889
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba CentraCare - Rice Memorial Hospital
- Infusion Therapy Clinic/Center
- Willmar, MN
- NPI 1124657150
Hospital
-
dba CentraCare Hospice
- Community Based Hospice Care Agency
- Willmar, MN
- NPI 1306359856
-
dba CentraCare - Rice Memorial Hospital
- General Acute Care Hospital
- Willmar, MN
- NPI 1407367030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680048000000",
"number": "1841266152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 WILLMAR AVE SW",
"city": "WILLMAR",
"state": "MN",
"postal_code": "56201",
"telephone_number": "320-231-5000",
"fax_number": "320-231-5067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 WILLMAR AVE SW",
"city": "WILLMAR",
"state": "MN",
"postal_code": "56201",
"telephone_number": "320-231-5000",
"fax_number": "320-231-5067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKLAWSKY",
"first_name": "MICHAEL",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2023-03-29",
"certification_date": "2023-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "36966",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036217400",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mnicklawsky29793@direct.centracare.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "mnicklawsky29793@direct.centracare.com",
"address_1": "101 Willmar Ave SW",
"city": "Willmar",
"state": "MN",
"country_code": "US",
"postal_code": "56201",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.