NPIMap

Individual provider Active NPI

Carly Nicole Smith, PA-C

  • Physician Assistant
  • Minnetonka, MN
National Provider Identifier
1043645690
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11656 Issued in MN
Practice address
5435 Feltl Rd
Minnetonka, MN 55343-7983
Phone
(952) 835-9880
NPI assigned
Sep 13, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085004730 IL
Physician Assistant 363A00000X 11656 MN Primary

Addresses

Primary practice location

5435 Feltl Rd
Minnetonka, MN 55343-7983

Mailing address

5435 Feltl Rd
Minnetonka, MN 55343-7983
Phone (952) 835-9880

Other names 1

  • Carly Nicole Larson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141020002032 MN Practitioner - Physician Assistant 8820219611 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians
Ear Nose and Throat Specialty Care of Minnesota PAGroup PAC ID 3274524020, 46 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321

303 Catlin St
Buffalo, MN 55313-1947

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

6099 Wayzata Blvd
Suite 200
St Louis Park, MN 55416-5538
Phone (612) 871-1144

800 E 28TH St
Minneapolis, MN 55407-3723

9822 Hospital Dr
Maple Grove, MN 55369-4648
Phone (612) 871-1144

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • Buffalo Hospital Hospital, Buffalo, MN, CCN 240076

Merit-based Incentive Payment System (MIPS)

Final score
77.11 of 100Reported as group
Quality
63.28
Promoting interoperability
91
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085004730ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Feb 15, 2021 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Feb 15, 2021 Accepting new patients
Ecc Addiction & Toxicology Services LLC Past Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212

303 Catlin St
Ste 100
Buffalo, MN 55313
Phone (763) 684-6160

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

3960 Coon Rapids Blvd NW
Ste 104
Minneapolis, MN 55433
Phone (763) 236-9000

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

Interoperability endpoints

  • Direct secure messaging: clarson269027@excellian.direct.allina.com

Organizations & group practices 9

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.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1043645690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 FELTL RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553437983",
            "telephone_number": "952-835-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5435 FELTL RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553437983",
            "telephone_number": "952-835-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CARLY",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-13",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085004730",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "LARSON",
            "middle_name": "NICOLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minnetonka, MN

Sources for this page

Verify at the official NPI Registry.