Katherine Rose Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14744 Issued in MN

Practice address

5109 36TH Ave N
Crystal, MN 55422

Phone

(763) 587-7999

Fax

(763) 587-7989

NPI assigned

Dec 5, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Katherine Rose Mattinen Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Touro Un Col of Osteopathic Medicine, Henderson, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Clinic PAGroup PAC ID 2769384205, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katherine.mattinen@nor.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/IJDFBA/Endpoint/IJDFBA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Clinic, PA

  • Family Medicine Physician
  • Brooklyn Park, MN
  • NPI 1114962206
  Medicare reassignment Care Compare group
• North Clinic, PA

  • Multi-Specialty Clinic/Center
  • Brooklyn Park, MN
  • NPI 1407011760
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• North Memorial Health Care

  • Ambulance
  • Brooklyn Center, MN
  • NPI 1538195912

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • Medical Specialty Clinic/Center
  • Robbinsdale, MN
  • NPI 1699953000

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1003683509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5109 36TH AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "55422",
            "telephone_number": "763-587-7999",
            "fax_number": "763-587-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5109 36TH AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "55422",
            "telephone_number": "763-587-7999",
            "fax_number": "763-587-7989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9825 Hospital Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694768",
            "country_code": "US",
            "telephone_number": "763-587-7999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHERINE",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-05",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "MATTINEN",
            "middle_name": "ROSE",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Bianca Xochitl Chipoco
• Sharon Keun Hae Chung, LICSW
• Jessica M Cici, MD
• Clinique Healthcare Services, Inc
• Collective Care Outpatient Services, LLC
• Colleen Martens Endrizzi, Inc.
• Pastor Colon, MD
• Comfort Care Nursing Services, Inc

• Physician Assistant in Crystal, MN
• Providers in Crystal, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.