NPIMap

Individual provider Active NPI

Jennifer Nicole Gannon, PA-C

  • Physician Assistant
  • Sartell, MN
National Provider Identifier
1447308770
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11639 Issued in MN
Practice address
101 Dehler Dr
Sartell, MN 56377-4407
Phone
(320) 845-2157
NPI assigned
Jan 5, 2007
Last updated
Apr 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 11639 MN Primary
Athletic Trainer 2255A2300X 1881 MN

Addresses

Primary practice location

101 Dehler Dr
Sartell, MN 56377-4407

Mailing address

101 Dehler Dr
Sartell, MN 56377-4407

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgannon246668@direct.centracare.com Direct

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
I20140825002746 MN Practitioner - Physician Assistant 8123246634 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1301 33Rd St S
St Cloud, MN 56301-9668
Phone (320) 251-8181

1900 Centracare Cir
Saint Cloud, MN 56303-5000

PO Box
Chicago, IL 60673

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1881MNMDMarriage & Family Therapist
11639MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Unity Family Healthcare CurrentSince Apr 13, 2015 Accepting new patients
Fairview Express Care CurrentSince Jul 18, 2022 Accepting new patients
Centracare Clinic CurrentSince Dec 1, 2024 Accepting new patients
Fairview Express Care CurrentSince Jul 18, 2022 Accepting new patients
Unity Family Healthcare CurrentSince Apr 13, 2015 Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

7892 Solutions Ctr
Chicago, IL 60677

320 3rd Ave
Albany, MN 56307
Phone (320) 845-2157

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1301 33rd St S
Saint Cloud, MN 56301
Phone (320) 240-6955

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

251 County Road 120
Sartell, MN 56303
Phone (320) 202-8949

Organizations & group practices 9

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 6

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1447308770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DEHLER DR",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DEHLER DR",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774407",
            "telephone_number": "320-845-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "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": "11639",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "1881",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgannon246668@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jgannon246668@direct.centracare.com",
            "address_1": "1301 33rd St S",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563019604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.