Individual provider Active NPI

Alexander Wilson, PA STUDENT

  • Physician Assistant
  • Plymouth, MN
National Provider Identifier
1578338331
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14807 Issued in MN
Practice address
2855 Campus Dr
Plymouth, MN 55441-2649
Phone
(763) 577-7160
Fax
(763) 577-7074
NPI assigned
Nov 21, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 14807 MN Primary

Addresses

Primary practice location

2855 Campus Dr
Plymouth, MN 55441-2649

Mailing address

2829 University Ave SE
Minneapolis, MN 55414-3230

Other practice location 1

2829 University Ave SE Ste 730
Minneapolis, MN 55414-3279
Phone (651) 241-8755

Other practice location 2

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

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
I20240307003868 MN Practitioner - Physician Assistant 8729424155 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

2855 Campus Dr
Plymouth, MN 55441-2649
Phone (763) 577-7160

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • Allina United Hospital Hospital, Saint Paul, MN, CCN 240038

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14807MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ecc Addiction & Toxicology Services LLC CurrentSince Nov 1, 2023 Accepting new patients
Allina Health System CurrentSince Apr 1, 2024 Accepting new patients
Allina Health System CurrentSince Apr 1, 2024 Accepting new patients
Allina Health System Past Accepting new patients

Locations

200 State Ave
Faribault, MN 55021
Phone (507) 334-6451

1175 Nininger Rd
Hastings, MN 55033
Phone (651) 404-1000

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2829 University Ave SE
Ste 730
Minneapolis, MN 55414
Phone (612) 439-1868

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

2250 NW 26th St
Owatonna, MN 55060
Phone (507) 451-3850

2855 Campus Dr
Plymouth, MN 55441
Phone (763) 577-7000

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1578338331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 UNIVERSITY AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 CAMPUS DR",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412649",
            "telephone_number": "763-577-7160",
            "fax_number": "763-577-7074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2829 University Ave SE Ste 730",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554143279",
            "country_code": "US",
            "telephone_number": "651-241-8755",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 Smith Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022344",
            "country_code": "US",
            "telephone_number": "651-241-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ALEXANDER",
        "credential": "PA STUDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-21",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.