THERESE B. M. PEDERSON (PA-C) – Physician Assistant, NPI 1336550979
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
Provider Addresses for THERESE B. M. PEDERSON (PA-C)
916 SAINT PETER ST
DELANO, MN 553282813
Phone: (952) 442-2191
Type: Mailing
560 S Maple St Ste 200
Waconia, MN 553871757
Phone: (952) 442-2163
Fax: (952) 442-5903
Type: Location
2829 UNIVERSITY AVE SE
MINNEAPOLIS, MN 55414
Phone: (612) 439-1860
Type: Mailing
333 SMITH AVE N
SAINT PAUL, MN 55102
Phone: (612) 863-6590
Type: Location
4200 DAHLBERG DR STE 300
GOLDEN VALLEY, MN 554224841
Phone: (952) 512-5600
Type: Mailing
560 S MAPLE ST STE 200
WACONIA, MN 553871757
Phone: (952) 442-2163
Fax: (952) 442-5903
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2014-08-19
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 |
|---|---|---|---|---|
| I20140819000026 | I | Physician Assistant | 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 | 80 | 73 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 31 | 31 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 19 | 19 | $0 |
Insurance plans in this area (ZIP 55328)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MN | |
| Internal Medicine | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| Physician Assistant | MN | |
| Diagnostic Radiology | MN | |
| Marriage And Family Therapist | MN | |
| Physician Assistant | MN | |
| Nurse Practitioner | MN |
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