Renae J Matthews, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12915 Issued in MN

Practice address

711 Delmore Dr- Altru Clinic/Roseau
Roseau, MN 56751-1534

Phone

(218) 463-1365

Fax

(704) 688-9651

NPI assigned

Jun 17, 2006

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 NC, MN2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095

  MN

  Medicare reassignment NPD
• Altru Health System

  • Clinic/Center
  • Crookston, MN
  • NPI 1760494330

  MN

  Medicare reassignment
• Promed Healthcare, PLLC

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1770615114

  NC

  Medicare reassignment
• Lifecare Medical Center

  • Rural Health Clinic/Center
  • Warroad, MN
  • NPI 1619724077
  NPD
• Altru Health System

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  NPD

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1467497487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891",
            "fax_number": "704-688-9651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DELMORE DR- ALTRU CLINIC/ROSEAU",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-1365",
            "fax_number": "704-688-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEWS",
        "first_name": "RENAE",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifecare Medical Center
• Lifecare Medical Center
• Lifecare Medical Center
• Lorris G. Vatnsdal, LTD.
• Jack Victor Lundbohm
• Mattson Pharmacy, Inc
• Kayla Marie McLaughlin, RN
• Mind Body Health & Wellness PA
• Prasad Munusamy, M.D.
• Erin Murray

• All providers in Roseau, MN
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.