Individual provider Active NPI

Cheryl Lynn Oeltjenbruns, PAC

  • Physician Assistant
  • Edina, MN
National Provider Identifier
1194701102
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9323 Issued in MN
Practice address
3400 W 66TH St Ste 150
Edina, MN 55435-2109
Phone
(952) 920-7200
Fax
(763) 302-4234
NPI assigned
Dec 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 9323 MN
Surgical Physician Assistant 363AS0400X 1951 WI
Physician Assistant 363A00000X 9323 MN Primary

Addresses

Primary practice location

3400 W 66TH St Ste 150
Edina, MN 55435-2109

Mailing address

3400 W 66TH St Ste 150
Edina, MN 55435-2109
Phone (952) 920-7200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address coeltjenbruns168038@direct.northmemorial.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060117000301 MN Practitioner - Physician Assistant 5597789602 Reassigns benefits to 1 organization
I20060223000478 WI Practitioner - Physician Assistant 5597789602 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minneapolis Clinic of Neurology LTDGroup PAC ID 5496668659, 75 clinicians

Practice addresses (Care Compare)

3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Phone (952) 920-7200

4225 Golden Valley Rd
Golden Valley, MN 55422-4215
Phone (763) 588-0661

Merit-based Incentive Payment System (MIPS)

Final score
92.39 of 100Reported as group
Quality
84.12
Promoting interoperability
100
Improvement activities
40
Cost
83.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1951WIMDChiropractor
9323MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Laboratory Corportation of America Holdings PastSince Aug 25, 2019 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: coeltjenbruns168038@direct.northmemorial.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.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1194701102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST STE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200",
            "fax_number": "763-302-4234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST STE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200",
            "fax_number": "763-302-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OELTJENBRUNS",
        "first_name": "CHERYL",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "9323",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "1951",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "coeltjenbruns168038@direct.northmemorial.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "3400 W 66th St Ste 150",
            "city": "Edina",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554352109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.