NPIMap

Individual provider Active NPI

Lydia Schroeder, PA-C

  • Physician Assistant
  • Park Rapids, MN
National Provider Identifier
1528616018
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13180 Issued in MN
Practice address
705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone
(218) 732-2800
NPI assigned
Aug 28, 2019
Last updated
Oct 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13180 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X PENDING MN

Addresses

Primary practice location

705 Pleasant Ave S
Park Rapids, MN 56470-1440

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951

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
I20191018002459 MN Practitioner - Physician Assistant 2365773512 Reassigns benefits to 1 organization

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
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians

Practice addresses (Care Compare)

1103 1St St E
Park Rapids, MN 56470-1879
Phone (218) 732-6300

212 Aspen Ave NE
Menahga, MN 56464-3289
Phone (218) 564-4131

615 6TH St W
Park Rapids, MN 56470-1379
Phone (218) 732-3329

619 6TH St W
Park Rapids, MN 56470-1301
Phone (218) 732-3329

705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone (218) 732-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PENDINGMNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary's Regional Health Center CurrentSince Oct 14, 2019 Accepting new patients
St Mary's Regional Health Center CurrentSince Oct 14, 2019 Accepting new patients
St Marys Regional Health Center Past Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

705 Pleasant Ave S
Park Rapids, MN 56470
Phone (218) 732-2800

Organizations & group practices 4

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": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1528616018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 PLEASANT AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701440",
            "telephone_number": "218-732-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHROEDER",
        "first_name": "LYDIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13180",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MN",
            "license": "PENDING",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Rapids, MN

Sources for this page

Verify at the official NPI Registry.