NPIMap

Individual provider Active NPI

Timothy J Hernandez, MD

  • Family Medicine Physician
  • West Saint Paul, MN
National Provider Identifier
1932110079
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30114 Issued in MN
Practice address
234 Wentworth Ave E
West Saint Paul, MN 55118-3525
Phone
(651) 455-2940
Fax
(651) 455-3354
NPI assigned
Aug 11, 2006
Last updated
Apr 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30114 MN Primary

Addresses

Primary practice location

234 Wentworth Ave E
West Saint Paul, MN 55118-3525

Mailing address

2025 Sloan PL Ste 35
Saint Paul, MN 55117-2092
Phone (651) 772-1572

Other identifiers 1

IdentifierTypeStateIssuer
189882500MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060424000516 MN Practitioner - Family Practice 2163334285 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mayo Medical School, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

234 Wentworth Ave E
West St Paul, MN 55118-3525
Phone (651) 788-4444

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
301149MNMDAddiction (Substance Use Disorder) Counselor
30114MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Jun 28, 2022 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Jun 28, 2022 Accepting new patients
Family Healthservices Minnesota, P.a. Family Medicine CurrentSince Jan 1, 2008 Accepting new patients
Healtheast Woodwinds Hospital Past Accepting new patients
Healtheast St. John's Hospital Past Accepting new patients
Allina Health System Past Accepting new patients
Family Healthservices Minnesota, P.a. Family Medicine Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2980 Buckley Way
Inver Grove Heights, MN 55076
Phone (651) 457-2748

2025 Sloan Pl
Ste 35
Saint Paul, MN 55117
Phone (651) 772-1572

2601 Centennial Dr
Ste 100
Saint Paul, MN 55109
Phone (651) 777-7414

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

580 Rice St
Saint Paul, MN 55103
Phone (651) 227-6551

234 Wentworth Ave E
West St Paul, MN 55118
Phone (651) 455-2940

Interoperability endpoints

  • Direct secure messaging: timothy.hernandez@entira.eclinicaldirectplus.com

Organizations & group practices 8

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.

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1932110079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 SLOAN PL STE 35",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551172092",
            "telephone_number": "651-772-1572",
            "fax_number": "651-772-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 WENTWORTH AVE E",
            "city": "WEST SAINT PAUL",
            "state": "MN",
            "postal_code": "551183525",
            "telephone_number": "651-455-2940",
            "fax_number": "651-455-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "30114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189882500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.