NPIMap

Individual provider Active NPI

Kathryn M Isaacson, PA-C

  • Physician Assistant
  • Otsego, MN
National Provider Identifier
1104277318
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12133 Issued in MN
Practice address
8540 Quaday Ave NE
Otsego, MN 55330-6522
Phone
(763) 441-0298
Fax
(763) 441-0591
NPI assigned
Jun 29, 2016
Last updated
Aug 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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 12133 MN Primary

Addresses

Primary practice location

8540 Quaday Ave NE
Otsego, MN 55330-6522

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

Other names 1

  • Kathryn M Samuelson 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
I20160803000904 MN Practitioner - Physician Assistant 1355635053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

11225 Ulysses St NE
Blaine, MN 55434-4261
Phone (763) 302-2600

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

8540 Quaday Ave NE
Otsego, MN 55330-6522
Phone (763) 441-0298

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12133MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Jul 9, 2016 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Jul 9, 2016 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

11225 Ulysses St NE
Blaine, MN 55434
Phone (763) 302-2600

3111 124th Ave NW
Ste 200
Coon Rapids, MN 55433
Phone (763) 427-7300

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

8540 Quaday Ave NE
Otsego, MN 55330
Phone (763) 441-0298

3545 Highway 61 N
Vadnais Heights, MN 55110

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1104277318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600",
            "fax_number": "952-512-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8540 QUADAY AVE NE",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553306522",
            "telephone_number": "763-441-0298",
            "fax_number": "763-441-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISAACSON",
        "first_name": "KATHRYN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "SAMUELSON",
            "middle_name": "M",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Otsego, MN

Sources for this page

Verify at the official NPI Registry.