Individual provider Active NPI

Cody Wayne Lawson, ATC

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1477168565
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2211 Riverside Ave
Minneapolis, MN 55454-1350
Phone
(612) 330-1000
NPI assigned
Sep 15, 2020
Last updated
Dec 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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 NU Primary
Athletic Trainer 2255A2300X NU

Addresses

Primary practice location

2211 Riverside Ave
Minneapolis, MN 55454-1350

Mailing address

115 2ND Ave S Apt 701
Minneapolis, MN 55401-2014
Phone (276) 618-1593

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 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
I20221221000040 VA Practitioner - Physician Assistant 1456721141 Reassigns benefits to 2 organizations
I20251218004088 NC Practitioner - Physician Assistant 1456721141 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Roanoke Valley Healthcare Partners LLCGroup PAC ID 0143490326, 53 clinicians
Emergency Physicians of TidewaterGroup PAC ID 5092618462, 167 clinicians

Practice addresses (Care Compare)

1119 N Military Hwy
Suite 300
Norfolk, VA 23502-2415
Phone (757) 224-3004

2800 Godwin Blvd
Suffolk, VA 23434-8038
Phone (757) 686-3508

325 Volvo Pkwy
Suite 103
Chesapeake, VA 23320-4654
Phone (757) 240-3500

4221 Tuckaseegee Rd
Charlotte, NC 28208-2801
Phone (704) 395-0060

4909 Green Rd
Raleigh, NC 27616-3418
Phone (919) 790-0288

602 Brandon Ave SW
Suite 222
Roanoke, VA 24015-3212
Phone (540) 774-0000

Merit-based Incentive Payment System (MIPS)

Final score
97.87 of 100Reported as group
Quality
95.04
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care of North Carolina, P.C. CurrentSince Dec 15, 2025 Accepting new patients
Short Pump Family Care, LLC PastSince Feb 1, 2016 Accepting new patients
Blue Ridge Healthcare Partners, LLC Past Accepting new patients

Locations

4221 Tuckaseegee Rd
Charlotte, NC 28208
Phone (704) 392-4057

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1477168565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 2ND AVE S APT 701",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554012014",
            "telephone_number": "276-618-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541350",
            "telephone_number": "612-330-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWSON",
        "first_name": "CODY",
        "middle_name": "WAYNE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-15",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.