Abby M Dettmer, DO
Individual provider Active NPI Family Medicine Physician · North Mankato, MN
NPI 1891706263 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1891706263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 50395 (MN)
- Practice address
- 1575 Lookout Dr
North Mankato, MN 56003-2503 - Phone
- (507) 625-1811
- NPI assigned
- Aug 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mankato Clinic LTD
Practice addresses (Care Compare)
1230 Main St E
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811
Hospital & facility affiliations
- Mayo Clinic Health System - Waseca
- Mayo Clinic Health System - Mankato
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080701000547 | MN | Practitioner - Family Practice | 3476550831 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-7613 | IA | MD | Family Medicine Physician |
| 50395 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mankato Clinic LTD | Family Medicine | Current |
Accepting new patients |
| Mayo Clinic Health System-Southwest Minnesota Region | Past | Accepting new patients | |
| Mercy Health Services-Iowa Corp | Past | Accepting new patients |
Locations
1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623
1575 Lookout Dr
North Mankato, MN 56003
Phone (507) 327-4726
501 State St N
Waseca, MN 56093
Phone (507) 835-1210
Interoperability endpoints
- abbydettmer@mklt.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R-7613 | IA | |
| Family Medicine Physician | 207Q00000X | 50395 | MN | Yes |
Addresses
Primary practice location
1575 Lookout Dr
North Mankato, MN 56003-2503
Mailing address
1575 Lookout Dr
North Mankato, MN 56003-2503
Phone (507) 625-1811
Other providers in North Mankato, MN
- Catalina Mercedes De la Cruz
- John H Decock
- Dehen Chiropractic, LTD.
- Mark David Dehen
- Jada Delacruz
- Andrea Nicole Diaz Pellot
- Molly Gene Dietz
- Ryan Dietz
- Krystal Dinwiddie
- Hongda Du
All providers in North Mankato, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.