Active NPI
Holly Lyne Beaulieu, PA-C
- Medical Physician Assistant
- Saint Paul, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 10419
- Practice address
- 1973 Sloan PL Ste 100
Saint Paul, MN 55117 - Phone
- (651) 241-5593
- Fax
- (651) 241-5870
- NPI assigned
- Jul 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 10419 | MN | Primary |
Addresses
Primary practice location
1973 Sloan PL Ste 100
Saint Paul, MN 55117
Mailing address
PO Box 14909
Minneapolis, MN 55414-0909
Phone (612) 871-1145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1185 Town Centre Dr
Suite 200
Eagan, MN 55123-1343
Phone (612) 871-1145
15700 37TH Ave N
Plymouth, MN 55446-3399
Phone (612) 871-1145
15700 37TH Ave N
Suite 300
Plymouth, MN 55446-3661
Phone (612) 871-1145
1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000
333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000
3588 Arcade St
Suite 110
Vadnais Heights, MN 55127-7135
Phone (612) 871-1145
9145 Springbrook Dr NW
Suite 300
Coon Rapids, MN 55433-5897
Phone (612) 871-1145
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10419 | MN | MD | Speech-Language Pathologist |
Interoperability endpoints
- holly.beaulieupa.p1@direct.mngastro.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Gastroenterology Physician
- Minneapolis, MN
- NPI 1609804541
Hospital & facility affiliations 17
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- St Paul, MN
- NPI 1265474704
Hospital
-
- General Acute Care Hospital
- Saint Paul, MN
- NPI 1457319485
-
- General Acute Care Hospital
- Hastings, MN
- NPI 1508457045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534204800000",
"number": "1528222197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 14909",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554140909",
"telephone_number": "612-871-1145",
"fax_number": "612-870-5491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1973 SLOAN PL STE 100",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "55117",
"telephone_number": "651-241-5593",
"fax_number": "651-241-5870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAULIEU",
"first_name": "HOLLY",
"middle_name": "LYNE",
"name_prefix": "Miss",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-14",
"last_updated": "2018-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MN",
"license": "10419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.