Individual provider Active NPI

Rachel Lu Nguyen, PA-C

  • Physician Assistant
  • Eagan, MN
National Provider Identifier
1053196022
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14661 Issued in MN
Practice address
845 Vikings Pkwy Ste B
Eagan, MN 55121-1139
Phone
(888) 938-3838
Fax
(888) 919-1083
NPI assigned
Aug 29, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14661 MN Primary

Addresses

Primary practice location

845 Vikings Pkwy Ste B
Eagan, MN 55121-1139

Mailing address

10001 W Innovation Dr Ste 200
Milwaukee, WI 53226-4851
Phone (888) 938-3838

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231013001430 MN Practitioner - Physician Assistant 5294180055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear Institutes LLCGroup PAC ID 4880928761, 12 clinicians

Practice addresses (Care Compare)

4365 Pheasant Ridge Dr NE
Suite 106
Blaine, MN 55449-4544
Phone (888) 938-3838

6640 Shady Oak Rd
Suite 255
Eden Prairie, MN 55344-7710
Phone (888) 938-3838

8401 Seasons Pkwy
Suite 300
Woodbury, MN 55125-3476
Phone (888) 938-3838

845 Vikings Pkwy
Suite B
Eagan, MN 55121-1139
Phone (888) 938-3838

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14661MNMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1053196022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 VIKINGS PKWY STE B",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211139",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "RACHEL",
        "middle_name": "LU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-29",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.