NPIMap

Individual provider Active NPI

Matthew Ray Bennett, PA-C

  • Surgical Physician Assistant
  • Waconia, MN
National Provider Identifier
1376955971
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2193 Issued in MN
Practice address
560 S Maple St
Suite 200
Waconia, MN 55387-1733
Phone
(952) 442-2163
Fax
(952) 442-5903
NPI assigned
May 30, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2193 MN Primary

Addresses

Primary practice location

560 S Maple St
Suite 200
Waconia, MN 55387-1733

Mailing address

4200 Dahlberg Dr
Suite 300
Golden Valley, MN 55422-4840
Phone (952) 512-5600

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
I20150122000229 MN Practitioner - Physician Assistant 5496975955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

100 Healthy Way
Olivia, MN 56277-1117
Phone (952) 442-2163

111 Hundertmark Rd
Suite 240
Chaska, MN 55318-1198
Phone (952) 456-7400

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

820 Village Way
Waconia, MN 55387-4612

965 Prairie Ctr Dr
Eden Prairie, MN 55344-3671

Hospital & facility affiliations

  • Olivia Hospital & Clinic Hospital, Olivia, MN, CCN 241306
  • Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

Merit-based Incentive Payment System (MIPS)

Final score
96.26 of 100Reported as group
Quality
89.75
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2193MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Jan 5, 2015 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Jan 5, 2015 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

111 Hundertmark Rd
Ste 240
Chaska, MN 55318
Phone (952) 456-7400

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

100 Healthy Way
Olivia, MN 56277
Phone (320) 523-1261

560 S Maple St
Ste 200
Waconia, MN 55387
Phone (952) 856-4033

820 Village Way
#200
Waconia, MN 55387

Organizations & group practices 24

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.

View all 24

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": "1401408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1376955971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR",
            "address_2": "SUITE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224840",
            "telephone_number": "952-512-5600",
            "fax_number": "952-512-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 S MAPLE ST",
            "address_2": "SUITE 200",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871733",
            "telephone_number": "952-442-2163",
            "fax_number": "952-442-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MATTHEW",
        "middle_name": "RAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-30",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "2193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.