Individual provider Active NPI

Troy Michael Evenson, PA C

  • Physician Assistant
  • Brooklyn Park, MN
National Provider Identifier
1609842632
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9710 Issued in MN
Practice address
5601 96TH Ave N Ste 200
Brooklyn Park, MN 55443-4505
Phone
(763) 786-9543
Fax
(763) 786-3320
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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 9710 MN Primary

Addresses

Primary practice location

5601 96TH Ave N Ste 200
Brooklyn Park, MN 55443-4505

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

Other identifiers 1

IdentifierTypeStateIssuer
408377600MedicaidMN

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
I20040219000173 MN Practitioner - Physician Assistant 7012802903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

11225 Ulysses St NE
Blaine, MN 55434-4261
Phone (763) 302-2600

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

3545 Hwy 61 N
Vadnais Heights, MN 55110-5223
Phone (651) 439-8807

5601 96TH Ave N
Brooklyn Park, MN 55443-4505
Phone (763) 786-9543

965 Prairie Ctr Dr
Eden Prairie, MN 55344-3671

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
526MNMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Feb 2, 2009 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Feb 2, 2009 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

11225 Ulysses St NE
Blaine, MN 55434
Phone (763) 302-2600

5601 96th Ave N
Ste 200
Brooklyn Park, MN 55443
Phone (763) 786-9543

2700 Vikings Cir
Eagan, MN 55121
Phone (952) 456-7600

7373 France Ave S
Ste 312
Edina, MN 55435
Phone (952) 832-0076

4010 W 65th St
Minneapolis, MN 55435
Phone (952) 456-7000

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

7866 12th Ave S
Minneapolis, MN 55425

16800 37th Pl N
#200
Plymouth, MN 55446
Phone (635) 207-8707

5715 Memorial Ave N
Stillwater, MN 55082
Phone (514) 398-8076

4040 Radio Dr
Woodbury, MN 55129
Phone (514) 398-8076

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1609842632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 96TH AVE N STE 200",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554434505",
            "telephone_number": "763-786-9543",
            "fax_number": "763-786-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVENSON",
        "first_name": "TROY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408377600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

Verify at the official NPI Registry.