MADELINE GRACE CARLSON – Physician Assistant, NPI 1629700968

MADELINE GRACE CARLSON is a healthcare provider. based in Duluth, Minnesota. specializing in PHYSICIAN ASSISTANT. The NPI Number for MADELINE GRACE CARLSON is 1629700968

Main info

Female
3 Years Of Experience
Accepts Medicare Assignment
Name
MADELINE GRACE CARLSON
NPI
1629700968
Phone
(218) 723-6289
Address
1200 KENWOOD AVE
Enumeration Date
27 June 2022
Last Update Date
27 June 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6514842724
Graduation Year
2023 (3 years ago)
PAC ID
8022454966
Group Practice PAC ID
4385633767
Professional Enrollment ID
I20240313003068
Address ID
MN551273674WH4480XRDXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience21
Completeness75
Years active:3State licenses:0Digital endpointsOther names

4,031 PHYSICIAN ASSISTANT in MN

Provider Addresses for MADELINE GRACE CARLSON

  • 1200 KENWOOD AVE

    DULUTH, MN 558114199

    Phone: (218) 723-6289

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 3 Open Payments records for all available years, with a total value of $56.

Total Amount is formed as General ($56) + Research ($0) + Ownership ($0) = $56.

Last reported payment date: 2024-06-20 • Largest payer in this snapshot: E.R. Squibb & Sons, L.L.C. ($21).

Total Amount

$56

General + Research + Ownership

Payments

3

Total payment records

General Amount

$56

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-20

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2024-03-13

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240313003068IPhysician AssistantMNTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55811)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4385633767View full group profile
NameSpecialtyState
D E R M A T O L O G YMN
Physician AssistantMN
Physician AssistantMN
Physician AssistantIL
Physician AssistantMN
Internal MedicineMN
Nurse PractitionerMN

Reviews

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Frequently asked questions

What number should I use to identify MADELINE GRACE CARLSON for billing?
Administrative and clinical systems typically use NPI 1629700968 for MADELINE GRACE CARLSON.
Quick check: is MADELINE GRACE CARLSON active?
Public NPPES data shows MADELINE GRACE CARLSON with an active NPI status right now.
What services align with MADELINE GRACE CARLSON's listing?
MADELINE GRACE CARLSON's public classification highlights Physician Assistant. Clinical services aligned with this taxonomy classification.
Is MADELINE GRACE CARLSON tied to Duluth, Minnesota?
If you are local to Duluth, Minnesota, MADELINE GRACE CARLSON may be relevant to your search.
Can I export MADELINE GRACE CARLSON's record?
You can download the official NPPES record; we summarize key fields for readability.

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