DR. JACK LEON-MAX MUTNICK (M.D.) – Internal Medicine Physician, NPI 1487601316
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
91 ALLERGY/IMMUNOLOGY in MN
Provider Addresses for DR. JACK LEON-MAX MUTNICK (M.D.)
3939 W 69TH ST STE A
EDINA, MN 554352001
Phone: (612) 930-8462
Fax: (800) 785-5608
Type: Location
3440, Molina Street, Shakopee, Scott County, Minnesota, 55379, United States
SHAKOPEE, MN 553795444
Phone: (714) 296-6777
Fax: (800) 785-5608
Type: Mailing
Intown on Lake, 1, West Lake Street, Lyndale, Minneapolis, Hennepin County, Minnesota, 55408, United States
MINNEAPOLIS, MN 554083154
Phone: (612) 823-2947
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 15 Open Payments records for all available years, with a total value of $326.
Total Amount is formed as General ($326) + Research ($0) + Ownership ($0) = $326.
Last reported payment date: 2024-09-03 • Largest payer in this snapshot: Medtronic, Inc. ($137).
Total Amount
$326
General + Research + Ownership
Payments
15
Total payment records
General Amount
$326
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-03
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medtronic, Inc. | $137 |
| PFIZER INC. | $54 |
| Dexcom, Inc. | $28 |
| Phadia US Inc. | $23 |
| Amgen Inc. | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-05-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100526001002 | I | Allergy/Immunology | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 132 | 50 | $0 |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 128 | 34 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 123 | 49 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 18 | 14 | $0 |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 13 | 13 | $0 |
Insurance plans in this area (ZIP 55435)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O T O L A R Y N G O L O G Y | MN | |
| Physician Assistant | MN | |
| O T O L A R Y N G O L O G Y | MN | |
| Qualified Audiologist | MN | |
| Nurse Practitioner | WA |
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