Mary Kathleen Anderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10146 Issued in MN

Practice address

480 Osborne Rd NE
Fridley, MN 55432-2773

Phone

(763) 785-4500

Fax

(763) 785-3329

NPI assigned

Nov 16, 2006

Last updated

Apr 3, 2012By the provider in NPPES

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 identifiers 4

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

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001
• Maple Grove Hospital Hospital, Maple Grove, MN, CCN 240214

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: manderson127917@direct.northmemorial.com

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

• North Memorial Health Care

  dba North Memorial Health Hospital

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Medicare reassignment Care Compare group
• North Memorial Health Care

  dba North Memorial Health Professional Services

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1568893220
  NPD
• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552
  NPD

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

• Maple Grove Hospital Corporation

  • General Acute Care Hospital
  • Maple Grove, MN
  • NPI 1225272552
  Care Compare affiliation
• North Memorial Health Care

  dba North Memorial Ambulance Service

  • Ambulance
  • Brooklyn Center, MN
  • NPI 1538195912

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  dba North Memorial Health Specialty Center - Robbinsdale

  • 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

  dba North Memorial Health Hospital

  • 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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333411200000",
    "number": "1013080316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322773",
            "telephone_number": "763-785-4500",
            "fax_number": "763-785-3329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322773",
            "telephone_number": "763-785-4500",
            "fax_number": "763-785-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2012-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MN",
            "identifier": "625A6AN",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "816420000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "138758",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP73373",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• American Transportation Inc
• Amoud Center Inc
• Alina Amunrud
• Samantha Andersen
• Joy Kristine Anderson, MD
• Molly-Jean Margaret Anderson, DC
• R M H Anderson
• Rhonda Lee Anderson, PT
• Sarah Diane Anderson
• Angel Center LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; 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.