Individual provider Active NPI

Alyssa Ann Marie Raiolo

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1346918695
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14795 Issued in MN
Practice address
333 Smith Ave N
Saint Paul, MN 55102-2344
Phone
(651) 241-8755
NPI assigned
Sep 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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 14795 MN Primary

Addresses

Primary practice location

333 Smith Ave N
Saint Paul, MN 55102-2344

Mailing address

2829 University Ave SE Ste 730
Minneapolis, MN 55414-3279
Phone (612) 439-1868

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
I20240813002761 MN Practitioner - Physician Assistant 2860930583 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ecc Addiction & Toxicology Services LLC CurrentSince Oct 25, 2020 Accepting new patients

Locations

2829 University Ave SE
Ste 730
Minneapolis, MN 55414
Phone (612) 439-1868

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

Organizations & group practices 2

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": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1346918695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 UNIVERSITY AVE SE STE 730",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143279",
            "telephone_number": "612-439-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SMITH AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022344",
            "telephone_number": "651-241-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAIOLO",
        "first_name": "ALYSSA",
        "middle_name": "ANN MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.