NPIMap

Individual provider Active NPI

Tiffany J Mellang

  • Physician Assistant
  • Roseville, MN
National Provider Identifier
1083196927
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1146349 Issued in MN
Practice address
2355 Highway 36 W Ste 100
Roseville, MN 55113-3905
Phone
(651) 292-2000
NPI assigned
Sep 6, 2018
Last updated
Jul 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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 1146349 MN Primary

Addresses

Primary practice location

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905

Mailing address

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905
Phone (651) 292-2000

Other practice location 1

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 710-1273

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
I20181030002699 MN Practitioner - Physician Assistant 2769735224 Reassigns benefits to 11 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Radiology PAGroup PAC ID 4486568482, 217 clinicians
Midwest Radiology Outpatient Imaging LLCGroup PAC ID 3870495591, 133 clinicians
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians
Suburban Imaging LLCGroup PAC ID 4688564867, 142 clinicians

Practice addresses (Care Compare)

101 Caring Way
Redwood Falls, MN 56283-2624
Phone (651) 292-2000

1175 Nininger Rd
Hastings, MN 55033-1056
Phone (651) 292-2000

1282 Walnut St
Dawson, MN 56232-2333
Phone (651) 292-2000

14000 Nicollet Ave
Suite 204
Burnsville, MN 55337-5796
Phone (651) 292-2000

14655 Galaxie Ave
Apple Valley, MN 55124-8602

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 292-2000

1815 Wisconsin Ave
Benson, MN 56215-1653
Phone (651) 292-2000

2355 Hwy 36 W
Suite 100
Roseville, MN 55113-3905
Phone (651) 292-2000

250 Thompson St
Saint Paul, MN 55102-2370
Phone (651) 292-2000

2925 Chicago Ave
Minneapolis, MN 55407-1321

30 S Behl St
Suite 100
Appleton, MN 56208-1616
Phone (651) 292-2000

301 Becker Ave SW
Willmar, MN 56201-3302
Phone (651) 292-2000

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 292-2000

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (651) 292-2000

4166 Lexington Ave N
Shoreview, MN 55126-6106
Phone (651) 241-1306

4194 Lexington Ave N
Shoreview, MN 55126-6106
Phone (651) 483-5461

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

503 E Lincoln St
Hendricks, MN 56136-9598
Phone (651) 292-2000

612 S Sibley Ave
Litchfield, MN 55355-3340
Phone (651) 292-2000

6401 France Ave S
Edina, MN 55435-2104
Phone (651) 292-2000

824 N 11TH St
Montevideo, MN 56265-1629
Phone (651) 292-2000

8675 Valley Creek Rd
Woodbury, MN 55125-2337
Phone (651) 241-3000

8990 Springbrook Dr NW
Suite 140
Coon Rapids, MN 55433-5880
Phone (763) 792-1900

9055 Springbrook Dr NW
Coon Rapids, MN 55433-5841
Phone (763) 780-9155

911 Northland Dr
Princeton, MN 55371-2172
Phone (651) 292-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.63 of 100Reported as group
Quality
90.16
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.17 of 100Reported as group
Quality
95
Improvement activities
40
Cost
82.21

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

Merit-based Incentive Payment System (MIPS)

Final score
91.56 of 100Reported as group
Quality
90.07
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.66 of 100Reported as group
Quality
79.17
Promoting interoperability
100
Improvement activities
40
Cost
73.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
12811MNMDPhysical Therapist
1146349MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Oct 4, 2018 Accepting new patients
St. Croix Regional Medical Center CurrentSince Jan 21, 2023 Accepting new patients
Allina Health System CurrentSince Apr 1, 2019 Accepting new patients
St. Croix Regional Medical Center CurrentSince Jan 21, 2023 Accepting new patients
Fairview Express Care CurrentSince May 1, 2021 Accepting new patients
Fairview Clinics CurrentSince Jan 21, 2023 Accepting new patients
Fairview Clinics CurrentSince Jan 21, 2023 Accepting new patients
Fairview Health Services CurrentSince Oct 4, 2018 Accepting new patients
Fairview Express Care CurrentSince May 1, 2021 Accepting new patients
Allina Health System CurrentSince Jan 21, 2023 Accepting new patients
Allina Health System CurrentSince Apr 1, 2019 Accepting new patients
NPI 1083910871 Past Accepting new patients
Consulting Radiologists, LTD Past Accepting new patients

Locations

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

14000 Nicollet Ave
Ste 204
Burnsville, MN 55337
Phone (952) 898-2333

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

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

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

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

6545 France Ave S
Ste 115
Minneapolis, MN 55435
Phone (952) 893-1997

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

Organizations & group practices 23

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.

View all 23

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1083196927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541450",
            "country_code": "US",
            "telephone_number": "612-710-1273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELLANG",
        "first_name": "TIFFANY",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-06",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1146349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.