Alexandra Nicole Koes, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13496 Issued in MN

Practice address

9645 Grove Cir N Ste 250
Maple Grove, MN 55369-2683

Phone

(763) 201-8191

NPI assigned

Aug 14, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Texas Tech University Health Science Center School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interventional Spine and Pain Physicians PAGroup PAC ID 2466606264, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Interventional Spine and Pain Physicians, PA

  • Specialist
  • Maple Grove, MN
  • NPI 1326398561
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1417503558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553692684",
            "telephone_number": "763-201-8191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553692683",
            "telephone_number": "763-201-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOES",
        "first_name": "ALEXANDRA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-14",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Naomi Knutson, OD
• Sally Knutson, RN
• Brenda Kodl
• Tara Koepke
• Jill Marie Koerber, P.T.
• Pamela Kolacz, M.D.
• Andrew John Kollath
• Patricia Ann Koning, DDS
• Ibolya Konkoly, DC
• Andrea Konz

• Physician Assistant in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; 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.