Brent D. Plackner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11906 Issued in MN

Practice address

970 Pickett St N
Bayport, MN 55003-1489

Phone

(651) 779-5713

Fax

(651) 747-1621

NPI assigned

Aug 30, 2005

Last updated

Jan 19, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516320000000",
    "number": "1487647996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2277 HIGHWAY 36 W STE 140",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133895",
            "telephone_number": "612-255-0628",
            "fax_number": "612-255-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 PICKETT ST N",
            "city": "BAYPORT",
            "state": "MN",
            "postal_code": "550031489",
            "telephone_number": "651-779-5713",
            "fax_number": "651-747-1621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLACKNER",
        "first_name": "BRENT",
        "middle_name": "D.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2018-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "865-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "004156125",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42958400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Bayport, MN
• Providers in Bayport, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.