Unknown Individual – Physician Assistant, NPI 1831538602
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
4240 PARK GLEN RD
ST LOUIS PARK, MN 554165427
Phone: (612) 925-6033
Fax: (612) 925-8496
Type: Mailing
149 THOMPSON AVE E STE 150
WEST ST PAUL, MN 551183238
Phone: (651) 450-0860
Fax: (651) 450-0759
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $127.
Total Amount is formed as General ($127) + Research ($0) + Ownership ($0) = $127.
Last reported payment date: 2024-12-11 • Largest payer in this snapshot: Teva Pharmaceuticals USA, Inc. ($55).
Total Amount
$127
General + Research + Ownership
Payments
9
Total payment records
General Amount
$127
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-11
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 339 | 97 | $0 |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 205 | 57 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 51 | 36 | $0 |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 26 | 22 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 25 | 25 | $0 |
Insurance plans in this area (ZIP 55416)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| - | MN | |
| Clinical Social Worker | MN | |
| Clinical Social Worker | WI | |
| - | MN | |
| - | MN | |
| - | MN | |
| Clinical Psychologist | MN | |
| Clinical Social Worker | MN | |
| - | MN |
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