Tara Barrack, PA-C
Individual provider Active NPI Surgical Physician Assistant · Maple Grove, MN
NPI 1104266865 · NPPES record last updated Apr 14, 2020
Key facts
- NPI
- 1104266865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- Practice address
- 9555 Upland LN N
Maple Grove, MN 55369-4485 - Phone
- (952) 993-1440
- NPI assigned
- Jun 26, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Park Nicollet Clinic
Tria Orthopaedic Center LLC
Practice addresses (Care Compare)
15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440
5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400
8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130809000534 | MN | Practitioner - Physician Assistant | 6800038464 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11382 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Health Services | Current |
Accepting new patients | |
| Tria Orthopaedic Center LLC | Current |
Accepting new patients | |
| Fairview Health Services | Current |
Accepting new patients | |
| Fairview Clinics | Current |
Accepting new patients | |
| Fairview Clinics | Current |
Accepting new patients | |
| Park Nicollet Clinic | Current |
Accepting new patients |
Locations
14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400
1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860
9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378
8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626
909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383
911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313
3931 Louisiana Ave S
St Louis Park, MN 55426
Phone (952) 993-3230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | Yes | ||
| Physician Assistant | 363A00000X | 11382 | MN |
Addresses
Primary practice location
9555 Upland LN N
Maple Grove, MN 55369-4485
Mailing address
9555 Upland LN N
Maple Grove, MN 55369-4485
Phone (952) 993-1440
Other practice location 1
2090 Woodwinds Dr Ste 200
Woodbury, MN 55125-2522
Phone (651) 968-5201
Other practice location 2
8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742
Other names
- Tara Garber
Other providers in Maple Grove, MN
- Ballantine Legacy, LLC
- Shelby R Banken
- Rachel Lillian Barger
- Kyle R Barker
- Rachael Barker
- Monika Barrett
- Maxim S Barsky
- Sara A. Barsness
- Jane Elizabeth Barthell
- Joseph W Bartoletti
All providers in Maple Grove, MN · Surgical Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.