NPIMap

Individual provider Active NPI

Kagen Arthur Waage

  • Medical Physician Assistant
  • Mahnomen, MN
National Provider Identifier
1154648921
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
410 4TH St NW
Mahnomen, MN 56557-4208
Phone
(218) 935-2514
Fax
(218) 935-2720
NPI assigned
May 3, 2010
Last updated
Dec 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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 10771 MS
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

410 4TH St NW
Mahnomen, MN 56557-4208

Mailing address

410 4TH St NW
Mahnomen, MN 56557-4208
Phone (218) 935-2514

Other identifiers 1

IdentifierTypeStateIssuer
71062MedicaidMN

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
I20100729000809 MN Practitioner - Physician Assistant 7810020773 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Range Regional Health ServicesGroup PAC ID 8022920024, 349 clinicians

Practice addresses (Care Compare)

402 E Platt Ave
Nashwauk, MN 55769-1147
Phone (218) 885-2858

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10771MNMDPhysical Therapist
1423MNMDAthletic Trainer
10771MSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Jul 5, 2018 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Aug 15, 2023 Accepting new patients
Range Regional Health Services CurrentSince Aug 1, 2014 Accepting new patients
Range Regional Health Services CurrentSince Aug 1, 2014 Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Oct 6, 2022 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Jul 5, 2018 Accepting new patients
St. Luke's Hospital of Duluth Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1656 Central St W
Bagley, MN 56621
Phone (218) 694-2384

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

1814 14th Ave E
Hibbing, MN 55746
Phone (218) 262-3441

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

Interoperability endpoints

  • Direct secure messaging: kwaage321493@fairview.direct-ci.com

Organizations & group practices 11

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 6

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": "1272844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1154648921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 4TH ST NW",
            "city": "MAHNOMEN",
            "state": "MN",
            "postal_code": "565574208",
            "telephone_number": "218-935-2514",
            "fax_number": "218-935-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 4TH ST NW",
            "city": "MAHNOMEN",
            "state": "MN",
            "postal_code": "565574208",
            "telephone_number": "218-935-2514",
            "fax_number": "218-935-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAAGE",
        "first_name": "KAGEN",
        "middle_name": "ARTHUR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-03",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "10771",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71062",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mahnomen, MN

Sources for this page

Verify at the official NPI Registry.