TRACY ANNE CHISHOLM (PA-C) – Surgical Physician Assistant, NPI 1740378033
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
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Provider Addresses for TRACY ANNE CHISHOLM (PA-C)
Koch Industries, Inc. | Lehigh Consumer Group, LLC, 4200, Dahlberg Drive, Glenwood Junction, Golden Valley, Hennepin County, Minnesota, 55422, United States
SUITE 300
GOLDEN VALLEY, MN 554224840
Phone: (952) 512-5600
Fax: (952) 512-5651
Type: Mailing
Oakdale Medical Building, 3366, Oakdale Avenue North, Robbinsdale, Hennepin County, Minnesota, 55422, United States
SUITE 103
ROBBINSDALE, MN 554222948
Phone: (763) 520-7870
Fax: (763) 520-7580
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: 2011-02-03
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 |
|---|---|---|---|---|
| I20110203001161 | 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 |
|---|---|---|---|---|
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 425 | 39 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 45 | 35 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 25 | 22 | $0 |
| 73502 | X-ray of hip, 2-3 views | 18 | 17 | $0 |
| 73030 | X-ray of shoulder, minimum of 2 views | 16 | 12 | $0 |
Insurance plans in this area (ZIP 55422)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Orthopedic Surgery | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | TX |
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