NPIMap

Individual provider Active NPI

Antoinette Youngdahl Palecek, MD

  • Family Medicine Physician
  • Grand Rapids, MN
National Provider Identifier
1629164983
Registry record updated Nov 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10036 Issued in ND
Practice address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 326-5000
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 10036 ND Primary

Addresses

Primary practice location

1601 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090909000533 MN Practitioner - Family Practice 0345214284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians

Practice addresses (Care Compare)

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.35 of 100Reported as group
Quality
88.69
Promoting interoperability
100
Improvement activities
40
Cost
76.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Itasca Clinic and Hospital CurrentSince Aug 1, 2009 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Aug 1, 2009 Accepting new patients
Itasca Nursing Home PastSince Oct 1, 2023 Accepting new patients

Locations

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

126 SE 1st Ave
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

Interoperability endpoints

  • Direct secure messaging: ayoungdahlpalecek414278@fairview.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Grand VillageGrand Rapids, MN, CCN 245368 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2023
Apr 21, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 5

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289433600000",
    "number": "1629164983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGDAHL PALECEK",
        "first_name": "ANTOINETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2010-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "10036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.