NPIMap

Individual provider Active NPI

Teia Rose Wolter

  • Physician Assistant
  • Sartell, MN
National Provider Identifier
1518500578
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13223 Issued in MN
Practice address
2251 Connecticut Ave S
Sartell, MN 56377-2486
Phone
(320) 253-5220
NPI assigned
Oct 22, 2019
Last updated
Nov 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

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 13223 MN Primary

Addresses

Primary practice location

2251 Connecticut Ave S
Sartell, MN 56377-2486

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516
Phone (320) 253-5220

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
I20191105001010 MN Practitioner - Physician Assistant 5294067682 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1900 Centracare Cir
Saint Cloud, MN 56303-5000

2000 23Rd St S
Sartell, MN 56377-4765
Phone (320) 202-8949

PO Box
Chicago, IL 60673

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13223MNMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Aug 1, 2020 Accepting new patients
Park Nicollet Clinic CurrentSince Mar 20, 2020 Accepting new patients
Group Health, Inc. CurrentSince Nov 18, 2019 Accepting new patients
Centracare Clinic CurrentSince Aug 1, 2020 Accepting new patients
Park Nicollet Clinic CurrentSince Mar 20, 2020 Accepting new patients
Group Health, Inc. CurrentSince Nov 18, 2019 Accepting new patients
Group Health, Inc. CurrentSince Nov 18, 2019 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

2251 Connecticut Ave S
Sartell, MN 56377
Phone (320) 253-5220

Interoperability endpoints

  • Direct secure messaging: twolter500765@direct.centracare.com

Organizations & group practices 11

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1518500578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "320-253-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772486",
            "telephone_number": "320-253-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLTER",
        "first_name": "TEIA",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-22",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.