Individual provider Active NPI

Devi Chettiar, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1609198167
Registry record updated Feb 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1372 Issued in MN
Practice address
920 2ND Ave S
Suite 400
Minneapolis, MN 55402-3318
Phone
(612) 659-7111
Fax
(612) 225-1591
NPI assigned
Feb 24, 2010
Last updated
Feb 24, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2010

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 1372 MN Primary

Addresses

Primary practice location

920 2ND Ave S
Suite 400
Minneapolis, MN 55402-3318

Mailing address

920 2ND Ave S
Suite 400
Minneapolis, MN 55402-3318
Phone (612) 659-7111

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
I20100701000745 MN Practitioner - Physician Assistant 4789715947 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Metro Dermatology PLLCGroup PAC ID 4688815343, 4 clinicians

Practice addresses (Care Compare)

400 Village Ctr Dr
North Oaks, MN 55127-7093
Phone 6517899800809

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Quality
100
Improvement activities
40
Cost
91.5

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1372MNMDPhysical Therapist
10690MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Nov 2, 2010 Accepting new patients
Group Health, Inc. CurrentSince Nov 2, 2010 Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

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.

NPI Registry JSON

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

{
    "created_epoch": "1266969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266969600000",
    "number": "1609198167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 2ND AVE S",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554023318",
            "telephone_number": "612-659-7111",
            "fax_number": "612-225-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 2ND AVE S",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554023318",
            "telephone_number": "612-659-7111",
            "fax_number": "612-225-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHETTIAR",
        "first_name": "DEVI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-24",
        "last_updated": "2010-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.