Individual provider Active NPI

Jacqueline A. Hass, PA-C

  • Physician Assistant
  • Rochester, MN
National Provider Identifier
1124522438
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13370 Issued in MN
Practice address
5255 Members Pkwy NW
Rochester, MN 55901-8381
Phone
(507) 218-3701
Fax
(651) 209-0514
NPI assigned
Mar 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 089709 IA
Physician Assistant 363A00000X 13370 MN Primary

Addresses

Primary practice location

5255 Members Pkwy NW
Rochester, MN 55901-8381

Mailing address

5255 Members Pkwy NW
Rochester, MN 55901-8381
Phone (507) 218-3701

Other names 1

  • Jacqueline A. Fisher Former name

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
I20200827000921 MN Practitioner - Physician Assistant 2365706496 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13370MNMDPhysical Therapist
089709IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prairiecare LLC PastSince Jun 28, 2020 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1124522438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5255 MEMBERS PKWY NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559018381",
            "telephone_number": "507-218-3701",
            "fax_number": "651-209-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 MEMBERS PKWY NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559018381",
            "telephone_number": "507-218-3701",
            "fax_number": "651-209-0514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASS",
        "first_name": "JACQUELINE",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "089709",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FISHER",
            "middle_name": "A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.