Individual provider Active NPI

Nicole Ann Naas

  • Physician Assistant
  • Plymouth, MN
National Provider Identifier
1104716885
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5900 Teakwood LN N Apt B
Plymouth, MN 55442-1589
Phone
(414) 627-9815
NPI assigned
Jul 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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 Primary

Addresses

Primary practice location

5900 Teakwood LN N Apt B
Plymouth, MN 55442-1589

Mailing address

5900 Teakwood LN N Apt B
Plymouth, MN 55442-1589
Phone (414) 627-9815

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
I20260310000382 MN Practitioner - Physician Assistant 9830672716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 502-6602

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Mar 1, 2026 Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2026 Accepting new patients

Locations

6401 University Ave NE
Minneapolis, MN 55432
Phone (763) 572-5706

Organizations & group practices 3

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 3

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": "1751846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1104716885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 TEAKWOOD LN N APT B",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421589",
            "telephone_number": "414-627-9815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 TEAKWOOD LN N APT B",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421589",
            "telephone_number": "414-627-9815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAAS",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.