NPIMap

Individual provider Active NPI

Stephanie Marie Nwala

  • Physician Assistant
  • Windom, MN
National Provider Identifier
1508129255
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2573 Issued in MN
Practice address
820 2ND Ave N
Windom, MN 56101-1761
Phone
(507) 831-1703
Fax
(507) 831-5668
NPI assigned
Jun 18, 2012
Last updated
Nov 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2573 MN Primary

Addresses

Primary practice location

820 2ND Ave N
Windom, MN 56101-1761

Mailing address

820 2ND Ave N
Windom, MN 56101-1761
Phone (507) 831-1703

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
I20161107001254 MN Practitioner - Physician Assistant 3072749423 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Care IncGroup PAC ID 3476447541, 156 clinicians
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1216 Ryans Rd
Worthington, MN 56187-1781
Phone (507) 372-6522

2020 Hospital Drive
Suite 2
Windom, MN 56101-1761
Phone (507) 831-1703

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12243MNMDPhysical Therapist
2573MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince May 5, 2024 Accepting new patients
Rural Health Care, Inc CurrentSince Sep 1, 2020 Accepting new patients
Rural Health Care, Inc CurrentSince Sep 1, 2020 Accepting new patients
Avera McKennan CurrentSince May 5, 2024 Accepting new patients
Avera McKennan Past Accepting new patients
Rural Health Care, Inc. Past Accepting new patients

Locations

300 S Bruce St
Ste 100
Marshall, MN 56258

2020 Hospital Dr
Ste 1
Windom, MN 56101
Phone (507) 831-1703

2020 Hospital Dr
Ste 2
Windom, MN 56101
Phone (507) 831-1703

820 2nd Ave N
Windom, MN 56101
Phone (507) 831-1370

1216 Ryans Rd
Ste 3
Worthington, MN 56187
Phone (507) 372-6522

305 S State St
Aberdeen, SD 57401
Phone (605) 229-3000

Interoperability endpoints

  • Direct secure messaging: stephanie.nwala@avera.sdhealthlink.net

Organizations & group practices 7

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479081600000",
    "number": "1508129255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 2ND AVE N",
            "city": "WINDOM",
            "state": "MN",
            "postal_code": "561011761",
            "telephone_number": "507-831-1703",
            "fax_number": "507-831-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 2ND AVE N",
            "city": "WINDOM",
            "state": "MN",
            "postal_code": "561011761",
            "telephone_number": "507-831-1703",
            "fax_number": "507-831-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWALA",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2016-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "2573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windom, MN

Sources for this page

Verify at the official NPI Registry.