Individual provider Active NPI

Maura Jean Walsh Clemons, PA-C

  • Physician Assistant
  • Stillwater, MN
National Provider Identifier
1427679703
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13696 Issued in MN
Practice address
1701 Curve Crest Blvd W Ste 104
Stillwater, MN 55082-6181
Phone
(651) 439-8807
Fax
(651) 439-0232
NPI assigned
Apr 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 13696 MN Primary

Addresses

Primary practice location

1701 Curve Crest Blvd W Ste 104
Stillwater, MN 55082-6181

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210916001704 MN Practitioner - Physician Assistant 9931506086 Reassigns benefits to 1 organization
I20211215002020 WI Practitioner - Physician Assistant 9931506086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

165 W Commerce Dr
Belle Plaine, MN 56011-2911
Phone (952) 777-5661

560 S Maple St
Waconia, MN 55387-1759

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

916 Saint Peter Ave E
Delano, MN 55328-2813
Phone (952) 442-7800

Hospital & facility affiliations

  • Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13696MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgeview Medical Center CurrentSince Aug 7, 2023 Accepting new patients
Ridgeview Medical Center CurrentSince Aug 7, 2023 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

165 W Commerce Dr
Belle Plaine, MN 56011
Phone (952) 777-5661

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

916 Saint Peter Ave E
Delano, MN 55328
Phone (763) 972-9172

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

Interoperability endpoints

  • Direct secure messaging: maura.clemons@811393367080964.direct.elationemr.com

Organizations & group practices 5

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 2

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": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1427679703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CURVE CREST BLVD W STE 104",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826181",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "MAURA",
        "middle_name": "JEAN WALSH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.