Individual provider Active NPI

Anmol G Clairmont, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1255970489
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12107 Issued in NC
Practice address
715 S 8TH St
Minneapolis, MN 55404-1210
Phone
(612) 873-6963
NPI assigned
Jan 6, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13330 MN
Physician Assistant 363A00000X 0010-12107 NC Primary
Medical Physician Assistant 363AM0700X 13330 MN

Addresses

Primary practice location

715 S 8TH St
Minneapolis, MN 55404-1210

Mailing address

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Other names 1

  • Anmol G Manchala Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20220323002876 NC Practitioner - Physician Assistant 7517396468 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurology and Pain Management, PLLCGroup PAC ID 6305895905, 15 clinicians

Practice addresses (Care Compare)

325 S Walton Dr
Benson, NC 27504-9396
Phone (919) 894-1003

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13330MNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ecc Addiction & Toxicology Services LLC Past Accepting new patients
Atlantic Radiology Associates PA PastSince Apr 1, 2022 Accepting new patients

Organizations & group practices 3

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": "1578268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1255970489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 S 8TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041210",
            "telephone_number": "612-873-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAIRMONT",
        "first_name": "ANMOL",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-06",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13330",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12107",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "13330",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANMOL",
            "last_name": "MANCHALA",
            "middle_name": "G",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.