Individual provider Active NPI

Brianna Kay Randall, PAC

  • Physician Assistant
  • Robbinsdale, MN
National Provider Identifier
1164954020
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12405 Issued in MN
Practice address
3366 Oakdale Ave N
Ste 104
Robbinsdale, MN 55422-2948
Phone
(763) 520-7870
Fax
(763) 520-7580
NPI assigned
Mar 30, 2017
Last updated
Nov 20, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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 12405 MN Primary

Addresses

Primary practice location

3366 Oakdale Ave N
Ste 104
Robbinsdale, MN 55422-2948

Mailing address

3366 Oakdale Ave N
Ste 104
Robbinsdale, MN 55422-2948
Phone (763) 520-7870

Other identifiers 1

IdentifierTypeStateIssuer
1164954020MedicaidMN

Other names 1

  • Brianna Kay Olson 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
I20170522001132 MN Practitioner - Physician Assistant 7214204353 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
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)

1000 W 140TH St
Unit 201
Burnsville, MN 55337-4833
Phone (952) 808-3000

11225 Ulysses St NE
Blaine, MN 55434-4261
Phone (763) 302-2600

16800 37TH PL N
Plymouth, MN 55446-2805
Phone (763) 520-7870

2700 Vikings Cir
Eagan, MN 55121-1002
Phone (952) 456-7600

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

4040 Radio Dr
Woodbury, MN 55129-3237
Phone (651) 439-8807

9630 Grove Cir N
Suite 200
Maple Grove, MN 55369-3492
Phone (763) 520-7870

Hospital & facility affiliations

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

State licenses

LicenseStateTypeSpecialty
12405MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince May 15, 2017 Accepting new patients
Infinite Health Collaborative, PA CurrentSince May 15, 2017 Accepting new patients
North Memorial Health Care CurrentSince Sep 15, 2024 Accepting new patients
North Memorial Health Care CurrentSince Sep 15, 2024 Accepting new patients
Adefris & Toppin Women's Specialists,MDPC Past Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

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

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

3366 Oakdale Ave N
Ste 104
Robbinsdale, MN 55422
Phone (612) 529-9131

3366 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 287-5000

Organizations & group practices 7

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 5

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": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511136000000",
    "number": "1164954020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3366 OAKDALE AVE N",
            "address_2": "STE 104",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222948",
            "telephone_number": "763-520-7870",
            "fax_number": "763-520-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 OAKDALE AVE N",
            "address_2": "STE 104",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222948",
            "telephone_number": "763-520-7870",
            "fax_number": "763-520-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "BRIANNA",
        "middle_name": "KAY",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-30",
        "last_updated": "2017-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164954020",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIANNA",
            "last_name": "OLSON",
            "middle_name": "KAY",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Robbinsdale, MN

Sources for this page

Verify at the official NPI Registry.