Terra Michele Menkosky, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14042 Issued in MN

Practice address

900 Long Lake Rd Ste 150
New Brighton, MN 55112-6414

Phone

(612) 213-2370

Fax

(612) 524-5571

NPI assigned

Sep 28, 2017

Last updated

Dec 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Terra M Fodstad Other name

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarus Dermatology PAGroup PAC ID 7911157946, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Clarus Dermatology PA

  dba Clarus Dermatology

  • MOHS-Micrographic Surgery Physician
  • New Brighton, MN
  • NPI 1740532340
  Medicare reassignment Care Compare group
• Pleasant Pediatrics PLC

  • Pediatrics Physician
  • Glendale, AZ
  • NPI 1467032649
  NPD (past)
• Pleasant Pediatrics PLC

  • Pediatrics Physician
  • Peoria, AZ
  • NPI 1477742807
  NPD (past)
• Pleasant Pediatrics PLC

  • Pediatrics Physician
  • Glendale, AZ
  • NPI 1619485489
  NPD (past)
• Pleasant Pediatrics PLC

  dba Pleasant Pediatrics

  • Pediatrics Physician
  • Peoria, AZ
  • NPI 1790025591
  NPD (past)

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1285143529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD STE 150",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126414",
            "telephone_number": "612-213-2370",
            "fax_number": "612-524-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD STE 150",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126414",
            "telephone_number": "612-213-2370",
            "fax_number": "612-524-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENKOSKY",
        "first_name": "TERRA",
        "middle_name": "MICHELE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6912",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRA",
            "last_name": "FODSTAD",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physician Assistant in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.