NPIMap

Individual provider Active NPI

Breanna J. Privratsky, PA-C

  • Physician Assistant
  • Crookston, MN
National Provider Identifier
1578041653
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12751 Issued in MN
Practice address
400 S Minnesota St
Crookston, MN 56716-1808
Phone
(121) 828-1910
Fax
(218) 281-9189
NPI assigned
Aug 1, 2018
Last updated
Dec 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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 12751 MN Primary

Addresses

Primary practice location

400 S Minnesota St
Crookston, MN 56716-1808

Mailing address

2401 Demers Ave
Grand Forks, ND 58201-4183
Phone (701) 780-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bprivratsky86337@direct.directaltru.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180920000051 MN Practitioner - Physician Assistant 8022369784 Reassigns benefits to 1 organization
I20201020003892 ND Practitioner - Physician Assistant 8022369784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Practice addresses (Care Compare)

1380 S Columbia Rd
Grand Forks, ND 58201-4059
Phone (701) 795-2000

23076 347TH St SE
Erskine, MN 56535-9466
Phone (218) 687-5317

400 S Minnesota St
Crookston, MN 56716-1808
Phone (218) 281-9100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12751MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System CurrentSince Jul 7, 2020 Accepting new patients
Altru Health System CurrentSince Aug 3, 2018 Accepting new patients
Altru Health System CurrentSince Aug 3, 2018 Accepting new patients
Altru Health System Past Accepting new patients

Locations

400 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9100

607 Demers Ave
East Grand Forks, MN 56721
Phone (218) 773-0357

19120 200th St
Greenbush, MN 56726
Phone (218) 782-2400

711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365

412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

Interoperability endpoints

  • Direct secure messaging: bprivratsky86337@direct.directaltru.org

Organizations & group practices 5

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 12

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": "1533081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1578041653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014183",
            "telephone_number": "701-780-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S MINNESOTA ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161808",
            "telephone_number": "121-828-1910",
            "fax_number": "218-281-9189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIVRATSKY",
        "first_name": "BREANNA",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-01",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bprivratsky86337@direct.directaltru.org",
            "affiliation": "N",
            "endpointDescription": "direct mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "400 S Minnesota St",
            "city": "Crookston",
            "state": "MN",
            "country_code": "US",
            "postal_code": "567161808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crookston, MN

Sources for this page

Verify at the official NPI Registry.