NPIMap

Individual provider Active NPI

Brooke Mary Benjamin, PA-C

  • Physician Assistant
  • Mankato, MN
National Provider Identifier
1336662410
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12438 Issued in MN
Practice address
1025 Marsh St
Mankato, MN 56001-4752
Phone
(507) 385-4863
NPI assigned
Jul 20, 2017
Last updated
Sep 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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 12438 MN Primary

Addresses

Primary practice location

1025 Marsh St
Mankato, MN 56001-4752

Mailing address

1025 Marsh St
Mankato, MN 56001-4752

Other names 1

  • Brooke Mary Gagnon Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bbenjamin108235@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170826000061 MN Practitioner - Physician Assistant 6901178805 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (507) 373-2384

701 Hewitt Blvd
Red Wing, MN 55066-2848
Phone (651) 267-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Jan 3, 2026 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Apr 1, 2022 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Apr 1, 2022 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

32021 County 24 Blvd
Cannon Falls, MN 55009
Phone (507) 263-6000

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

Interoperability endpoints

  • Direct secure messaging: bbenjamin108235@ehrdirect.mayoclinicmsg.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1500508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1336662410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-385-4863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENJAMIN",
        "first_name": "BROOKE",
        "middle_name": "MARY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-20",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bbenjamin108235@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1025 Marsh St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560014752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "GAGNON",
            "middle_name": "MARY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.