Active NPI
Robert W. Neilson, M.D.
- Internal Medicine Physician
- Winona, MN
National Provider Identifier
1952390338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 52693
- Practice address
- 855 Mankato Ave
Winona, MN 55987-4868 - Phone
- (507) 454-3650
- Fax
- (507) 474-3392
- NPI assigned
- Oct 18, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | L4594 | TX | |
| Internal Medicine Physician | 207R00000X | 52693 | MN | Primary |
Addresses
Primary practice location
855 Mankato Ave
Winona, MN 55987-4868
Mailing address
855 Mankato Ave
Winona, MN 55987-4868
Phone (507) 454-3650
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 78718 | Other | NM | PRESBYTERIAN COMMERCIAL |
| 86723Z | Other | TX | HMO BLUE |
| 151183401 | Medicaid | TX | |
| 77871367 | Medicaid | NM | |
| 100159800A | Medicaid | OK | |
| 131010101 | Other | TX | FIRSTCARE COMMERCIAL |
| A535 | Other | NM | TRIWEST |
| 8B2602 | Other | TX | BC/BS |
| 78718 | Medicaid | NM | |
| 131010100 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104705 | MN | MD | Specialist |
| 52693 | MN | MD | Internal Medicine Physician |
Interoperability endpoints
- robert.neilson@direct.myteamcare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330473600000",
"number": "1952390338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "855 MANKATO AVE",
"city": "WINONA",
"state": "MN",
"postal_code": "559874868",
"telephone_number": "507-454-3650",
"fax_number": "507-474-3392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 MANKATO AVE",
"city": "WINONA",
"state": "MN",
"postal_code": "559874868",
"telephone_number": "507-454-3650",
"fax_number": "507-474-3392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEILSON",
"first_name": "ROBERT",
"middle_name": "W.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2012-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TX",
"license": "L4594",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "52693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN COMMERCIAL",
"identifier": "78718",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMO BLUE",
"identifier": "86723Z",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151183401",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77871367",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100159800A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTCARE COMMERCIAL",
"identifier": "131010101",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIWEST",
"identifier": "A535",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "8B2602",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "78718",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131010100",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winona, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.