NPIMap

Individual provider Active NPI

Jordyn Marisa Lira, PA

  • Physician Assistant
  • Cambridge, MN
National Provider Identifier
1124526462
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15242 Issued in MN
Practice address
701 Dellwood St S
Cambridge, MN 55008-1920
Phone
(763) 689-8700
NPI assigned
Jan 31, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 15242 MN Primary

Addresses

Primary practice location

701 Dellwood St S
Cambridge, MN 55008-1920

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Other names 1

  • Jordyn Marisa Peterson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpeterson656370@excellian.direct.allina.com Direct

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
I20250206003163 MN Practitioner - Physician Assistant 6103356084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

10705 Town Square Dr NE
Suite 100
Blaine, MN 55449-8185
Phone (763) 236-5400

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008-1920
Phone (763) 688-8700

Hospital & facility affiliations

  • Cambridge Medical Center Hospital, Cambridge, MN, CCN 240020
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Mar 10, 2025 Accepting new patients
Allina Health System CurrentSince Mar 10, 2025 Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

8100 W 78th St
Ste 230
Minneapolis, MN 55439
Phone (888) 892-7575

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

9300 Noble Pkwy N
Minneapolis, MN 55443
Phone (763) 236-5300

Interoperability endpoints

  • Direct secure messaging: jpeterson656370@excellian.direct.allina.com

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1124526462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DELLWOOD ST S",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081920",
            "telephone_number": "763-689-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIRA",
        "first_name": "JORDYN",
        "middle_name": "MARISA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-31",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpeterson656370@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "701 Dellwood St S",
            "city": "Cambridge",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550081920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JORDYN",
            "last_name": "PETERSON",
            "middle_name": "MARISA",
            "credential": "ATC/LAT, PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cambridge, MN

Sources for this page

Verify at the official NPI Registry.