Individual provider Active NPI

Jill M Wilkens, PA-C

  • Physician Assistant
  • Wadena, MN
National Provider Identifier
1457665986
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10825 Issued in MN
Practice address
4 Deerwood Ave
Wadena, MN 56482
Phone
(218) 631-1360
NPI assigned
Jul 26, 2010
Last updated
Jun 7, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

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 10825 MN Primary

Addresses

Primary practice location

4 Deerwood Ave
Wadena, MN 56482

Mailing address

4 Deerwood Ave
Wadena Medical Center
Wadena, MN 56482

Other identifiers 1

IdentifierTypeStateIssuer
1457665986OtherMNNPI

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
I20101201000422 MN Practitioner - Physician Assistant 5092901140 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Astera HealthGroup PAC ID 2961395272, 106 clinicians

Practice addresses (Care Compare)

4 Deerwood Ave NW
Wadena, MN 56482-1253
Phone (218) 631-1360

415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7495

415 Jefferson St N
Wadena, MN 56482-1296

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10825MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Astera Health CurrentSince Jun 1, 2011 Accepting new patients
Perham Hospital District CurrentSince Aug 1, 2019 Accepting new patients
Perham Hospital District CurrentSince Aug 1, 2019 Accepting new patients
Sibley Medical Center Past Accepting new patients
Allina Health System Past Accepting new patients

Locations

105 Otter Dr
Ottertail, MN 56571
Phone (218) 367-6111

1000 Coney St W
Perham, MN 56573
Phone (218) 347-1200

4 Deerwood Ave NW
Wadena, MN 56482
Phone (218) 631-1100

415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510

421 11th St NW
Wadena, MN 56482
Phone (218) 631-3510

Interoperability endpoints

  • Direct secure messaging: jwilkens25726@direct.centracare.com

Organizations & group practices 6

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 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": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307404800000",
    "number": "1457665986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 DEERWOOD AVE",
            "address_2": "WADENA MEDICAL CENTER",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "56482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 DEERWOOD AVE",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "56482",
            "telephone_number": "218-631-1360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKENS",
        "first_name": "JILL",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2011-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1457665986",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wadena, MN

Sources for this page

Verify at the official NPI Registry.