Individual provider Active NPI

Sommer Nicole Vaughan, PA-C

  • Physician Assistant
  • Waconia, MN
National Provider Identifier
1104932748
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9844 Issued in MN
Practice address
560 S Maple St
Suite 200
Waconia, MN 55387-1733
Phone
(952) 442-2163
Fax
(952) 442-5903
NPI assigned
Aug 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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 9844 MN Primary

Addresses

Primary practice location

560 S Maple St
Suite 200
Waconia, MN 55387-1733

Mailing address

4200 Dahlberg Dr
Suite 300
Golden Valley, MN 55422-4840
Phone (952) 512-5600

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
I20050223000768 MN Practitioner - Physician Assistant 4880647403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
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)

111 Hundertmark Rd
Suite 240
Chaska, MN 55318-1198
Phone (952) 456-7400

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

4010 W 65TH St
Edina, MN 55435-1706
Phone (952) 456-7000

820 Village Way
Waconia, MN 55387-4612

Hospital & facility affiliations

  • Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

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

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Apr 5, 2005 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Apr 5, 2005 Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

111 Hundertmark Rd
Ste 240
Chaska, MN 55318
Phone (952) 456-7400

6363 France Ave S
Ste 404
Minneapolis, MN 55435
Phone (952) 927-4525

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

4010 W 65th St
Minneapolis, MN 55435
Phone (952) 456-7000

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

4695 Shoreline Dr
Spring Park, MN 55384
Phone (952) 442-7890

3545 Highway 61 N
Vadnais Heights, MN 55110

560 S Maple St
Ste 200
Waconia, MN 55387
Phone (952) 856-4033

204 Lewis Ave S
Ste 201
Watertown, MN 55388
Phone (952) 442-2137

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1104932748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR",
            "address_2": "SUITE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224840",
            "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": "560 S MAPLE ST",
            "address_2": "SUITE 200",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871733",
            "telephone_number": "952-442-2163",
            "fax_number": "952-442-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "SOMMER",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.