Individual provider Active NPI

Cynthia S Jansen, PAC

  • Physician Assistant
  • Blaine, MN
National Provider Identifier
1457335044
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
10705 Town Square Dr NE Ste 210
Blaine, MN 55449-8187
Phone
(763) 284-2992
Fax
(763) 427-8131
NPI assigned
Dec 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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 Primary

Addresses

Primary practice location

10705 Town Square Dr NE Ste 210
Blaine, MN 55449-8187

Mailing address

820 Springer Dr
Lombard, IL 60148-6413
Phone (815) 744-8554

Other identifiers 1

IdentifierTypeStateIssuer
764480900MedicaidMN

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
I20100114000850 MN Practitioner - Physician Assistant 7618019530 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Dermatology SCGroup PAC ID 8628353380, 145 clinicians

Practice addresses (Care Compare)

10705 Town Square Dr NE
Suite 210
Blaine, MN 55449-8187
Phone (763) 231-8700

779 Bielenberg Dr
Suite 108
Woodbury, MN 55125-4432
Phone (763) 231-8700

Merit-based Incentive Payment System (MIPS)

Final score
89.8 of 100Reported as group
Promoting interoperability
88
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9378MNMDDoula

Interoperability endpoints

  • Direct secure messaging: cjansen@pinnacleskin.emadirect.md
  • Direct secure messaging: cindy.jansen@qdp.emadirect.md

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": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1457335044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 SPRINGER DR",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601486413",
            "telephone_number": "815-744-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10705 TOWN SQUARE DR NE STE 210",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554498187",
            "telephone_number": "763-284-2992",
            "fax_number": "763-427-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "CYNTHIA",
        "middle_name": "S",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-06",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "764480900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.