Active NPI
Rebecca Lenore Ertsgaard, PA-C
- Physician Assistant
- Blaine, MN
National Provider Identifier
1629623525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 13052
- Practice address
- 11091 Ulysses St NE Ste 100
Blaine, MN 55434-4238 - Phone
- (612) 879-1000
- Fax
- (612) 879-0722
- NPI assigned
- Aug 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 13052 | MN | Primary |
Addresses
Primary practice location
11091 Ulysses St NE Ste 100
Blaine, MN 55434-4238
Mailing address
3601 Minnesota Dr Ste 200
Bloomington, MN 55435-5281
Phone (612) 879-1000
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2828 Chicago Ave
Suite 200
Minneapolis, MN 55407-4187
Phone (612) 879-1000
Hospital & facility affiliations
- Mercy Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13052 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quest Diagnostics LLC Il | Past | Accepting new patients |
Interoperability endpoints
- rebeccaertsgaard@direct.noranclinic.com
Organizations & group practices 2
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.
-
- Specialist
- Bloomington, MN
- NPI 1710098306
-
- Clinical Medical Laboratory
- Chicago, IL
- NPI 1669298055
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Addiction (Substance Use Disorder) Psychologist
- Fridley, MN
- NPI 1083197214
Hospital
-
- General Acute Care Hospital
- Cambridge, MN
- NPI 1215755400
-
- Substance Use Disorder Rehabilitation Hospital Unit
- Fridley, MN
- NPI 1285692145
-
- General Acute Care Hospital
- Coon Rapids, MN
- NPI 1316904287
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fridley, MN
- NPI 1598700528
Hospital
-
- Psychiatric Hospital Unit
- Fridley, MN
- NPI 1609056100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1629623525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 MINNESOTA DR STE 200",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554355281",
"telephone_number": "612-879-1000",
"fax_number": "612-879-9116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11091 ULYSSES ST NE STE 100",
"city": "BLAINE",
"state": "MN",
"postal_code": "554344238",
"telephone_number": "612-879-1000",
"fax_number": "612-879-0722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERTSGAARD",
"first_name": "REBECCA",
"middle_name": "LENORE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-07",
"last_updated": "2024-05-20",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "13052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.