Emmah Kaye Griswold, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15521 Issued in MN

Practice address

4480 Centerville Rd
White Bear Lake, MN 55127-3674

Phone

(651) 484-2724

NPI assigned

Oct 20, 2025

Last updated

Jun 20, 2026By 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

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, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Advanced Dermatology Care Medical Cosmetic and Surgery PA

  dba Advanced Dermatology Care

  • Dermatology Physician
  • White Bear Lake, MN
  • NPI 1073614558
  Medicare reassignment
• Advanced Dermatology Care Medical Cosmetic and Surgery PA

  dba Advanced Dermatology Care

  • Dermatology Physician
  • Stillwater, MN
  • NPI 1144486978
  NPD
• Advanced Dermatology Care Medical Cosmetic and Surgery PA

  dba Advanced Dermatology Care

  • Dermatology Physician
  • Forest Lake, MN
  • NPI 1912158031
  NPD (past)

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

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781913600000",
    "number": "1013884691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551273674",
            "telephone_number": "651-484-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551273674",
            "telephone_number": "651-484-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISWOLD",
        "first_name": "EMMAH",
        "middle_name": "KAYE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-20",
        "last_updated": "2026-06-20",
        "certification_date": "2026-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katerina Goncharuk, PHARD
• Grand St Paul CVS LLC (CVS Pharmacy # 01776)
• Grand St Paul CVS LLC (CVS Pharmacy #07175)
• Jennifer Ann Vermeer Gregor, M.S.W., L.I.C.S.W.
• Olivia Grev, NP
• Kadi Groppoli
• Group Health, Inc. (HealthPartners White Bear Dental Clinic)
• Group Healthplan Inc (HealthPartners White Bear Lake Clinic)
• Groves Physical Therapy
• Brian Dwight Grudem, O.D.

• Physician Assistant in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2026; 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.