Individual provider Active NPI

Shauna Marissa Pankratz

  • Physician Assistant
  • Spring Lake Park, MN
National Provider Identifier
1528353711
Registry record updated Jun 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
8232 Highway 65 NE
Spring Lake Park, MN 55432-2095
Phone
(763) 577-1877
Fax
(763) 577-1887
NPI assigned
Jun 15, 2011
Last updated
Jun 15, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2011

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 Primary

Addresses

Primary practice location

8232 Highway 65 NE
Spring Lake Park, MN 55432-2095

Mailing address

2355 126TH Ave NW
Coon Rapids, MN 55448-2512
Phone (651) 336-9254

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110802000650 MN Practitioner - Physician Assistant 3476722760 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

11225 Ulysses St NE
Blaine, MN 55434-4261
Phone (763) 302-2600

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Apr 9, 2017 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Nov 7, 2018 Accepting new patients
Fairview Clinics CurrentSince Apr 9, 2017 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Nov 7, 2018 Accepting new patients
Fairview Health Services CurrentSince Apr 12, 2014 Accepting new patients
Fairview Express Care CurrentSince Apr 9, 2017 Accepting new patients
Fairview Clinics CurrentSince Apr 9, 2017 Accepting new patients
Fairview Health Services CurrentSince Apr 12, 2014 Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

11225 Ulysses St NE
Blaine, MN 55434
Phone (763) 302-2600

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308096000000",
    "number": "1528353711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 126TH AVE NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482512",
            "telephone_number": "651-336-9254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8232 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322095",
            "telephone_number": "763-577-1877",
            "fax_number": "763-577-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANKRATZ",
        "first_name": "SHAUNA",
        "middle_name": "MARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Lake Park, MN

Sources for this page

Verify at the official NPI Registry.