NPIMap

Individual provider Active NPI

Judy Pauletich, CNP

  • Adult Health Nurse Practitioner
  • Maplewood, MN
National Provider Identifier
1528500360
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R111663-4 Issued in MN
Practice address
1255 Mayhill Rd N
Maplewood, MN 55119-7158
Phone
(715) 529-6213
NPI assigned
Nov 10, 2016
Last updated
Mar 29, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R111663-4 MN Primary

Addresses

Primary practice location

1255 Mayhill Rd N
Maplewood, MN 55119-7158

Mailing address

1255 Mayhill Rd N
Maplewood, MN 55119-7158
Phone (715) 529-6213

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
I20170104000058 MN Practitioner - Nurse Practitioner 1254382757 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Lights Health LLCGroup PAC ID 6305278797, 11 clinicians

Practice addresses (Care Compare)

212 W Lake St
Waconia, MN 55387-1014
Phone (651) 603-4565

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.69 of 100Reported as group
Quality
91.97
Improvement activities
40
Cost
69.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R111663-4MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Jan 11, 2021 Accepting new patients
Northern Lights Health LLC Adult Health CurrentSince Dec 15, 2019 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Jan 11, 2021 Accepting new patients
Healtheast Medical Research Institute CurrentSince Jun 26, 2017 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Waterside Healthcare & Wellness, LLC CurrentSince Dec 29, 2019 Accepting new patients
Healtheast Medical Research Institute CurrentSince Jun 26, 2017 Accepting new patients

Locations

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

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

Organizations & group practices 8

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 5

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": "1478736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490745600000",
    "number": "1528500360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 MAYHILL RD N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551197158",
            "telephone_number": "715-529-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 MAYHILL RD N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551197158",
            "telephone_number": "715-529-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULETICH",
        "first_name": "JUDY",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-10",
        "last_updated": "2017-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R111663-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

Verify at the official NPI Registry.