Madeline Grace Carlson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

10705 Town Square Dr NE Ste 210
Blaine, MN 55449-8187

Phone

(763) 284-2992

Fax

(763) 427-8131

NPI assigned

Jun 27, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology Care Medical Cosmetic and Surgery PAGroup PAC ID 4385633767, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: mcarlson@adc.emadirect.md
• Direct secure messaging: madeline.carlson.p1@direct.tcpain.nextgenshare.com

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.

• Advanced Dermatology Care Medical Cosmetic and Surgery PA

  • Dermatology Physician
  • White Bear Lake, MN
  • NPI 1073614558
  Medicare reassignment Care Compare group NPD (past)
• Skin Professionals West, P.C.

  • Dermatology Physician
  • Waconia, MN
  • NPI 1992394944
  Medicare reassignment

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

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1629700968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734240",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606734244",
            "telephone_number": "629-519-6543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10705 TOWN SQUARE DR NE STE 210",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554498187",
            "telephone_number": "763-284-2992",
            "fax_number": "763-427-8131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4725 36th Ave N",
            "address_purpose": "LOCATION",
            "city": "Crystal",
            "state": "MN",
            "postal_code": "554222169",
            "country_code": "US",
            "telephone_number": "218-208-2058",
            "fax_number": "763-231-8701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "MADELINE",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-27",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629700968",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Campodonico Family & Cosmetic Dentistry PC
• Carlos Ernesto Campodonico, DDS
• Carefident Health Services
• Careteam Home LLC
• Lauren Carlson, R.D, L.D
• Emma Jo Carmichael
• Lisa Cassman
• Rebecca J Cebuhar, PHARMD
• Center for Mental Health and Wellness, LLC
• Andrew Thomas Chadbourn, DMD

• Physician Assistant in Blaine, MN
• Providers in Blaine, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; 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.

Verify at the official NPI Registry.