NPIMap

Individual provider Active NPI

Brita Lara Wegener, PA-C

  • Medical Physician Assistant
  • Forest Lake, MN
National Provider Identifier
1487889929
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
1540 Lake St S
Forest Lake, MN 55025-2628
Phone
(651) 464-7100
NPI assigned
May 28, 2009
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MN Primary

Addresses

Primary practice location

1540 Lake St S
Forest Lake, MN 55025-2628

Mailing address

1540 Lake St S
Forest Lake, MN 55025-2628
Phone (651) 464-7100

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bwegener68333@excellian.direct.allina.com Direct

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
I20090820000681 MN Practitioner - Physician Assistant 3971657248 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 87 NPIs, 3,844 clinicians
CCM HealthGroup PAC ID 4284539453, shared by 7 NPIs, 69 clinicians

Practice addresses (Care Compare)

1540 Lake St S
Forest Lake, MN 55025-2628
Phone (651) 464-7100

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

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients

Locations

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

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

1540 Lake St S
Forest Lake, MN 55025
Phone (651) 464-7100

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

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

920 E 28th St
Ste 560
Minneapolis, MN 55407
Phone (612) 863-3770

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

Interoperability endpoints

  • Direct secure messaging: bwegener68333@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 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1487889929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 LAKE ST S",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252628",
            "telephone_number": "651-464-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 LAKE ST S",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252628",
            "telephone_number": "651-464-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEGENER",
        "first_name": "BRITA",
        "middle_name": "LARA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-28",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bwegener68333@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1540 Lake St S",
            "city": "Forest Lake",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550252628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Forest Lake, MN

Sources for this page

Verify at the official NPI Registry.