NPIMap

Individual provider Active NPI

Matthew Wallner Brostrom, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1477182160
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13679 Issued in MN
Practice address
913 E 26TH St Ste 600
Minneapolis, MN 55404-4515
Phone
(612) 775-6200
Fax
(612) 775-6222
NPI assigned
Apr 3, 2020
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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 13679 MN Primary
Physician Assistant 363A00000X 8469 AZ

Addresses

Primary practice location

913 E 26TH St Ste 600
Minneapolis, MN 55404-4515

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Other practice location 1

9321 W Thomas Rd Ste 202
Phoenix, AZ 85037-3392
Phone (866) 974-2673

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Rosemount Health Information Exchange (HIE)

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
I20240618002283 MN Practitioner - Physician Assistant 9234538984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

2855 Campus Dr
Plymouth, MN 55441-2683

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

913 E 26TH St
Minneapolis, MN 55404-4515

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.65 of 100Reported as group
Quality
76.23
Promoting interoperability
100
Improvement activities
40
Cost
75.95

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13679MNMDDentist
8469AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Jun 3, 2024 Accepting new patients
Allina Health System CurrentSince Jun 3, 2024 Accepting new patients
Allina Health System Past Accepting new patients
Center for Orthopedic Research and Education, LLC Physician Assistant PastSince Feb 1, 2024 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

913 E 26th St
Ste 600
Minneapolis, MN 55404
Phone (612) 775-6257

2855 Campus Dr
Ste 300
Plymouth, MN 55441
Phone (763) 520-2900

2855 Campus Dr
Ste 600
Plymouth, MN 55441
Phone (612) 333-4822

1155 County Road E E
Ste 100
Vadnais Heights, MN 55110
Phone (651) 241-9200

8675 Valley Creek Rd
Woodbury, MN 55125
Phone (651) 241-3000

Interoperability endpoints

  • Direct secure messaging: matthew.brostrom.p2@direct.tcspine.nextgenshare.com
  • Direct secure messaging: mbrostrom314717@excellian.direct.allina.com

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.

Hospital & facility affiliations 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1477182160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 E 26TH ST STE 600",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044515",
            "telephone_number": "612-775-6200",
            "fax_number": "612-775-6222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9321 W Thomas Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850373392",
            "country_code": "US",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROSTROM",
        "first_name": "MATTHEW",
        "middle_name": "WALLNER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-03",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13679",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8469",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Rosemount",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14120 Burnley Way",
            "city": "Rosemount",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550682255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.