Michael Kenneth Hudalla, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

44193 Issued in MN

Practice address

49725 County 83
Staples, MN 56479-5280

Phone

(218) 894-1515

Fax

(218) 894-1316

NPI assigned

Oct 25, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Minnesota Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakewood Health SystemGroup PAC ID 1052229671, shared by 15 NPIs, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakewood Health System Home Care & Hospice Home health agency, Staples, MN, CCN 247124
• Lakewood Health System Hospital, Staples, MN, CCN 241329
• Lakewood Health System Nursing home, Staples, MN, CCN 245420

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mhudalla633948@direct.ochin.org

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.

• Lakewood Health System

  • Critical Access Hospital
  • Staples, MN
  • NPI 1295726362
  Medicare reassignment NPD
• Lakewood Health System

  dba Lakewood Clinic Staples

  • Rural Health Clinic/Center
  • Staples, MN
  • NPI 1841280823
  Medicare reassignment NPD
• Lakewood Health System

  • Critical Access Hospital
  • Staples, MN
  • NPI 1124019054
  NPD
• Lakewood Health System

  dba Longbella Drug by Lakewood Health System - Pillager Clinic

  • Community/Retail Pharmacy
  • Pillager, MN
  • NPI 1396519906
  NPD
• Lakewood Health System

  • Nursing Facility/Intermediate Care Facility
  • Staples, MN
  • NPI 1699766733
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lakewood Health System

  • Critical Access Hospital
  • Staples, MN
  • NPI 1295726362
  Care Compare affiliation
• Lakewood Health System

  dba Lakewood Health System Home Care and Hospice

  • Home Health Agency
  • Staples, MN
  • NPI 1477544542
  Care Compare affiliation

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891785424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-894-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-894-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDALLA",
        "first_name": "MICHAEL",
        "middle_name": "KENNETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "44193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald Wayne Henrickson, MD
• Craig Henson, M.D.
• Heidi Marie Hoppe, RN, ACNS, PMHNP
• HPM of Minnesota PLLC
• Alexandra Mae Hradsky, MD
• Christopher Douglas Hughes, MD
• Donald B Hughes, MD
• Independent School District 2170
• Infinite Health Collaborative, PA (Twin Cities Orthopedics)
• Sarah Jane Israelson, M.D.

• Family Medicine Physician in Staples, MN
• Providers in Staples, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.