Individual provider Active NPI

Jessie Lauren Nelson, PA-C

  • Physician Assistant
  • Blaine, MN
National Provider Identifier
1255860268
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12434 Issued in MN
Practice address
11225 Ulysses St NE
Blaine, MN 55434-4261
Phone
(763) 302-2600
Fax
(763) 302-2601
NPI assigned
Jun 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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 12434 MN Primary

Addresses

Primary practice location

11225 Ulysses St NE
Blaine, MN 55434-4261

Mailing address

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

Other names 1

  • Jessie Lauren Marolt 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
I20170812000426 MN Practitioner - Physician Assistant 3375814130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
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)

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

3545 Hwy 61 N
Vadnais Heights, MN 55110-5223
Phone (651) 439-8807

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 Feb 1, 2019 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Feb 1, 2019 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

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

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

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

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

4040 Radio Dr
Woodbury, MN 55129
Phone (514) 398-8076

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": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1255860268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11225 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344261",
            "telephone_number": "763-302-2600",
            "fax_number": "763-302-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11225 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344261",
            "telephone_number": "763-302-2600",
            "fax_number": "763-302-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JESSIE",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-05",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSIE",
            "last_name": "MAROLT",
            "middle_name": "LAUREN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.