Individual provider Active NPI

Amy R Wise, PA-C

  • Physician Assistant
  • Waconia, MN
National Provider Identifier
1245602481
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14659 Issued in MN
Practice address
820 Village Way Ste 200
Waconia, MN 55387-4612
Phone
(952) 442-2163
Fax
(952) 456-7895
NPI assigned
Oct 27, 2015
Last updated
Aug 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

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 14659 MN Primary

Addresses

Primary practice location

820 Village Way Ste 200
Waconia, MN 55387-4612

Mailing address

3500 American Blvd W Ste 300
Bloomington, MN 55431-4442
Phone (952) 486-5143

Other names 1

  • Amy R Kennedy 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
I20231114001514 MN Practitioner - Physician Assistant 9234586165 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia College of Osteopathic Medicine, 2023
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)

111 Hundertmark Rd
Suite 240
Chaska, MN 55318-1198
Phone (952) 456-7400

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

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

820 Village Way
Waconia, MN 55387-4612

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

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Dec 11, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Dec 11, 2023 Accepting new patients
North Memorial Health Care CurrentSince Jul 1, 2024 Accepting new patients
North Memorial Health Care CurrentSince Jul 1, 2024 Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

111 Hundertmark Rd
Ste 240
Chaska, MN 55318
Phone (952) 361-2450

9630 Grove Cir N
Ste 200
Maple Grove, MN 55369
Phone (763) 520-7580

3500 American Blvd W
Ste 300
Minneapolis, MN 55431
Phone (952) 512-5600

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

16800 37th Pl N
#200
Plymouth, MN 55446
Phone (635) 207-8707

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

820 Village Way
#200
Waconia, MN 55387

Organizations & group practices 6

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 2

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": "1445904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1245602481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 AMERICAN BLVD W STE 300",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554314442",
            "telephone_number": "952-486-5143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 VILLAGE WAY STE 200",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874612",
            "telephone_number": "952-442-2163",
            "fax_number": "952-456-7895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "AMY",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-27",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "KENNEDY",
            "middle_name": "R",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.