Jenna Wiese
Individual provider Active NPI Physician Assistant · Pillager, MN
NPI 1174197883 · NPPES record last updated Mar 10, 2022
Key facts
- NPI
- 1174197883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 13798 (MN)
- Practice address
- 680 Pillsbury St N
Pillager, MN 56473-2507 - Phone
- (218) 746-4527
- NPI assigned
- May 17, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- St Josephs Medical Center
Practice addresses (Care Compare)
13060 Isle Dr
Baxter, MN 56425-8331
Phone (218) 828-2880
523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7394
680 Pillsbury St N
Pillager, MN 56473-2507
Phone (218) 746-4527
Hospital & facility affiliations
- Essentia Health St Joseph'S Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211222002083 | MN | Practitioner - Physician Assistant | 9931590106 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13798 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph'S Medical Center | Current |
Accepting new patients | |
| The Duluth Clinic, LTD. | Current |
Accepting new patients | |
| St Joseph'S Medical Center | Current |
Accepting new patients | |
| St. Joseph'S Medical Center | Past | Accepting new patients |
Locations
523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
680 Pillsbury St N
Pillager, MN 56473
Phone (218) 746-4527
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | 13798 | MN | Yes |
Addresses
Primary practice location
680 Pillsbury St N
Pillager, MN 56473-2507
Mailing address
680 Pillsbury St N
Pillager, MN 56473-2507
Phone (218) 746-4527
Other providers in Pillager, MN
- Pillager Country Dental LLC
- Clinton Lawrence Roberts
- Lindsay Solheim
- St. Joseph'S Medical Center
- Up North Eye Care, P.a.
- Kathy E Wimmer
All providers in Pillager, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.