Individual provider Active NPI

Jason Hicks, PA

  • Physician Assistant
  • Waconia, MN
National Provider Identifier
1306885033
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9243 Issued in MN
Practice address
500 S Maple St
Waconia, MN 55387-1752
Phone
(952) 442-2191
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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 9243 MN Primary

Addresses

Primary practice location

500 S Maple St
Waconia, MN 55387-1752

Mailing address

PO Box 81
Chaska, MN 55318-0081
Phone (888) 398-3327

Other identifiers 2

IdentifierTypeStateIssuer
36D52HIOtherBCBS
HP36290OtherHEALTH PARTNERS

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
I20090618000656 MN Practitioner - Physician Assistant 5890846588 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

500 S Maple St
Waconia, MN 55387-1752
Phone (952) 442-2191

7907 Powers Blvd
Chanhassen, MN 55317-9502
Phone (952) 934-0570

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Valley Health Center Inc CurrentSince Apr 26, 2021 Accepting new patients
Ridgeview Medical Center CurrentSince Feb 2, 2010 Accepting new patients
Ridgeview Medical Center CurrentSince Feb 2, 2010 Accepting new patients
Sibley Medical Center CurrentSince Jul 1, 2014 Accepting new patients
Emergency Physicians & Consultants, PA Past Accepting new patients

Locations

601 W Chandler St
Arlington, MN 55307
Phone (507) 964-2271

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

111 Hundertmark Rd
Ste 120
Chaska, MN 55318
Phone (952) 856-4001

621 S 4th St
Le Sueur, MN 56058
Phone (507) 665-3375

4695 Shoreline Dr
Spring Park, MN 55384
Phone (952) 442-7890

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

560 S Maple St
Ste 220
Waconia, MN 55387
Phone (952) 442-8011

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196726400000",
    "number": "1306885033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 81",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553180081",
            "telephone_number": "888-398-3327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S MAPLE ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871752",
            "telephone_number": "952-442-2191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "JASON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "36D52HI",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP36290",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.