Derek K Groeneweg, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

2598 Issued in MN

Practice address

300 S Bruce St
Marshall, MN 56258-1934

Phone

(507) 537-9007

Fax

(507) 537-2734

NPI assigned

Sep 1, 2016

Last updated

Oct 21, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avera MarshallGroup PAC ID 5799695227, 102 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Avera Marshall Regional Medical Ctr Hospital, Marshall, MN, CCN 241359
• Avera Tyler Hospital Hospital, Tyler, MN, CCN 241348
• Avera Granite Falls Hospital, Granite Falls, MN, CCN 241343

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: derek.groeneweg@avera.sdhealthlink.net

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.

• Avera Marshall

  dba Avera Marshall Regional Medical Center

  • Critical Access Hospital
  • Marshall, MN
  • NPI 1568401016
  Medicare reassignment Care Compare group NPD
• Avera Granite Falls

  dba Avera Medical Group Granite Falls

  • Family Medicine Physician
  • Granite Falls, MN
  • NPI 1700429644
  Medicare reassignment NPD
• Avera Marshall

  dba Avera Medical Group Optometry - Marshall

  • Optometrist
  • Marshall, MN
  • NPI 1487422465
  NPD
• Avera Marshall

  dba Avera Eye Care Tracy

  • Optometrist
  • Tracy, MN
  • NPI 1487958062
  NPD
• Avera Marshall

  dba Avera Marshall Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Marshall, MN
  • NPI 1962641936
  NPD (past)
• Avera Tyler

  dba Avera Medical Group Ivanhoe

  • Rural Health Clinic/Center
  • Ivanhoe, MN
  • NPI 1063949089
  NPD (past)
• Granite Falls Municipal Hospital and Manor

  • Critical Access Hospital
  • Granite Falls, MN
  • NPI 1780654962
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Avera Granite Falls

  dba Avera Granite Falls Health Center

  • Critical Access Hospital
  • Granite Falls, MN
  • NPI 1700429610
  Care Compare affiliation
• Avera Marshall

  dba Avera Marshall Regional Medical Center

  • Critical Access Hospital
  • Marshall, MN
  • NPI 1568401016
  Care Compare affiliation
• Avera Tyler

  dba Avera Tyler Hospital

  • Critical Access Hospital
  • Tyler, MN
  • NPI 1801840517
  Care Compare affiliation

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1255888772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S BRUCE ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581934",
            "telephone_number": "507-537-9007",
            "fax_number": "507-537-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S BRUCE ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581934",
            "telephone_number": "507-537-9007",
            "fax_number": "507-537-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROENEWEG",
        "first_name": "DEREK",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "2598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael John Goblish
• Shannon Katrina Gossen, RN
• Shelli Lee Green, LAT, ATC
• Jennifer Joann Gregoire, LICSW
• Brent Eugene Griffin, MD
• Linda S Grong, AUD
• Guza Hearing Enhancement Inc
• H&L Orthodontics, PLLC
• Gloria Haag
• Jennifer Haedrich

• Surgical Physician Assistant in Marshall, MN
• Providers in Marshall, MN by specialty
• Surgical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.