Active NPI
Gregory D Zike Sr., PA
- Physician Assistant
- Eden Prairie, MN
National Provider Identifier
1013167956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0134
- Practice address
- 8966 Gould Rd
Eden Prairie, MN 55347-3326 - Phone
- (605) 610-5648
- NPI assigned
- Sep 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0134 | SD | Primary |
| Physician Assistant | 363A00000X | 1588 | IA |
Addresses
Primary practice location
8966 Gould Rd
Eden Prairie, MN 55347-3326
Mailing address
8966 Gould Rd.
Eden Prairie, MN 55347
Phone (605) 610-5648
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9042 | MN | MD | Speech-Language Pathologist |
| 0134 | SD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera McKennan | Past | Accepting new patients | |
| Hoven Medical Clinic Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Critical Access Hospital Clinic/Center
- Milbank, SD
- NPI 1013024009
-
- Rural Health Clinic/Center
- Hoven, SD
- NPI 1003886250
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375228800000",
"number": "1013167956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8966 GOULD RD.",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "55347",
"telephone_number": "605-610-5648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8966 GOULD RD",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553473326",
"telephone_number": "605-610-5648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIKE",
"first_name": "GREGORY",
"middle_name": "D",
"name_suffix": "Sr.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-29",
"last_updated": "2013-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0134",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "1588",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.