Dr Jack Leon-max Mutnick, MD - Medicare Allergy/immunology in St Louis Park, MN

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Dr Jack Leon-max Mutnick, MD is a medicare enrolled "Allergy & Immunology" physician in St Louis Park, Minnesota. He went to University Of Nevada School Of Medicine and graduated in 2004 and has 21 years of diverse experience with area of expertise as Allergy/immunology. He is a member of the group practice Primary Ent, L.l.c., Life Medical Pa, Minnesota Medical And Rehabilitative Services Llc and his current practice location is 4201 Excelsior Blvd, St Louis Park, Minnesota. You can reach out to his office (for appointments etc.) via phone at (952) 933-8900.

Dr Jack Leon-max Mutnick is licensed to practice in Minnesota (license number 48180) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1487601316.

Contact Information

Dr Jack Leon-max Mutnick, MD
4201 Excelsior Blvd,
St Louis Park, MN 55416-4728
(952) 933-8900
(952) 945-9536

Map and Direction




Physician's Profile

Full NameDr Jack Leon-max Mutnick
GenderMale
SpecialityAllergy/immunology
Experience21 Years
Location4201 Excelsior Blvd, St Louis Park, Minnesota
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dr Jack Leon-max Mutnick attended and graduated from University Of Nevada School Of Medicine in 2004
  NPI Data:
  • NPI Number: 1487601316
  • Provider Enumeration Date: 05/27/2006
  • Last Update Date: 10/14/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 1658400866
  • Enrollment ID: I20100526001002

Medical Identifiers

Medical identifiers for Dr Jack Leon-max Mutnick such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1487601316NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207K00000XAllergy & Immunology 48180 (Minnesota)Primary
207R00000XInternal Medicine 48180 (Minnesota)Secondary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Primary Ent, L.l.c.16587540155
Life Medical Pa62049383509
Minnesota Medical And Rehabilitative Services Llc64067647034

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jack Leon-max Mutnick allows following entities to bill medicare on his behalf.
Entity NameLife Medical Pa
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1740222496
PECOS PAC ID: 6204938350
Enrollment ID: O20070221000166
Entity NameMinnesota Medical And Rehabilitative Services Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1154302545
PECOS PAC ID: 6406764703
Enrollment ID: O20100728001200
Entity NamePrimary Ent, L.l.c.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1386374593
PECOS PAC ID: 1658754015
Enrollment ID: O20220817002202

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jack Leon-max Mutnick is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Jack Leon-max Mutnick, MD
3440 Molina St,
Shakopee, MN 55379-5444

Ph: (714) 296-6777		Dr Jack Leon-max Mutnick, MD
4201 Excelsior Blvd,
St Louis Park, MN 55416-4728

Ph: (952) 933-8900

Reviews and Comments


Allergy & Immunology Doctors in St Louis Park, MN

Dr. Alexandra Rose Graden, M.D.
Allergy & Immunology
Medicare: Accepting Medicare Assignments
Practice Location: 3800 Park Nicollet Blvd, St Louis Park, MN 55416
Phone: 952-993-3123    Fax: 952-993-3286
David Graft, MD
Allergy & Immunology
Medicare: Not Enrolled in Medicare
Practice Location: 3800 Park Nicollet Blvd, St Louis Park, MN 55416
Phone: 952-993-3094    
Pamela J Harris, MD
Allergy & Immunology
Medicare: Accepting Medicare Assignments
Practice Location: 3800 Park Nicollet Blvd, St Louis Park, MN 55416
Phone: 952-993-3090    Fax: 952-993-3916
Brenda Guyer, MD
Allergy & Immunology
Medicare: Not Enrolled in Medicare
Practice Location: 3800 Park Nicollet Blvd, St Louis Park, MN 55416
Phone: 952-993-3094    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.