Active NPI
Rebecca Cantwell, PA
- Surgical Physician Assistant
- Fridley, MN
National Provider Identifier
1558425967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1369
- Practice address
- 500 Osborne Rd NE
Fridley, MN 55432-2765 - Phone
- (763) 236-2180
- Fax
- (763) 236-2067
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1369 | MN | Primary |
Addresses
Primary practice location
500 Osborne Rd NE
Fridley, MN 55432-2765
Mailing address
500 Osborne Rd NE
Fridley, MN 55432-2765
Phone (763) 236-2180
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1369 | Other | MN | STATE MEDICAL LICENSE |
| 50.001798 | Other | OH | STATE OF OHIO MEDICAL BOA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1369 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Immediate Health Associates | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1558425967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 OSBORNE RD NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554322765",
"telephone_number": "763-236-2180",
"fax_number": "763-236-2067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 OSBORNE RD NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554322765",
"telephone_number": "763-236-2180",
"fax_number": "763-236-2067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANTWELL",
"first_name": "REBECCA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MN",
"license": "1369",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LICENSE",
"identifier": "1369",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF OHIO MEDICAL BOA",
"identifier": "50.001798",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.