Individual provider Active NPI

Timothy Sebastian Fisher, MD

  • Diagnostic Radiology Physician
  • Eden Prairie, MN
National Provider Identifier
1891758298
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A69168 Issued in CA
Practice address
11995 Singletree LN Ste 500
Eden Prairie, MN 55344-5349
Phone
(952) 595-1301
Fax
(612) 294-4903
NPI assigned
Apr 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A69168 CA Primary

Addresses

Primary practice location

11995 Singletree LN Ste 500
Eden Prairie, MN 55344-5349

Mailing address

11995 Singletree LN Ste 500
Eden Prairie, MN 55344-5349
Phone (952) 595-1301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100107000238 CA Practitioner - Diagnostic Radiology 8921065004 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A69168CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fred Smeltzer MD & Associates Inc Diagnostic Radiology CurrentSince Mar 1, 2022 Accepting new patients
Quality Medical Imaging of Arizona, Inc CurrentSince Jul 15, 2014 Accepting new patients
California Cancer Specialists Medical Group Inc Past Accepting new patients
Piedmont Diagnostic Radiology PC Diagnostic Radiology Past Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
N & S Wellness Solution Center LLC Past Accepting new patients
N&S Fund Management Inc Past Accepting new patients
Northern Virginia Radiology Consultants, PLLC Diagnostic Radiology Past Accepting new patients

Locations

11995 Singletree Ln
Ste 500
Eden Prairie, MN 55344
Phone (952) 595-1143

Organizations & group practices 9

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": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1891758298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "TIMOTHY",
        "middle_name": "SEBASTIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-08",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A69168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.