Individual provider Active NPI

Diane K. Samson, PA-C

  • Physician Assistant
  • Bloomington, MN
National Provider Identifier
1689627606
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13040 Issued in MN
Practice address
600 W 98TH St
Bloomington, MN 55420-4773
Phone
(952) 885-6150
NPI assigned
May 19, 2006
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-001315 IL
Physician Assistant 363A00000X 13040 MN Primary

Addresses

Primary practice location

600 W 98TH St
Bloomington, MN 55420-4773

Mailing address

13966 Redwood St NW
Andover, MN 55304-4135
Phone (630) 334-0968

Other practice location 1

1324 N Sheridan Rd
Waukegan, IL 60085-2161
Phone (630) 334-0968

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
I20191014000288 MN Practitioner - Physician Assistant 5395772875 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone (612) 626-5775

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (952) 914-1732

600 W 98TH St
Bloomington, MN 55420-4773
Phone (952) 881-2651

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

6545 France Ave S
Suite 150
Edina, MN 55435-2180
Phone (952) 848-5600

Merit-based Incentive Payment System (MIPS)

Final score
92.35 of 100Reported as group
Quality
91.74
Promoting interoperability
100
Improvement activities
40
Cost
77.13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-001315ILMDPhysician Assistant
13040MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Sep 14, 2019 Accepting new patients
Fairview Health Services CurrentSince Sep 14, 2019 Accepting new patients
Fairview Clinics CurrentSince Sep 14, 2019 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Sep 14, 2019 Accepting new patients
Fairview Health Services CurrentSince Sep 14, 2019 Accepting new patients
Healtheast Medical Research Institute CurrentSince Sep 14, 2019 Accepting new patients
Fairview Health Services Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

6545 France Ave S
Ste 150
Edina, MN 55435
Phone (952) 848-5600

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

400 Stinson Blvd
Minneapolis, MN 55413
Phone (612) 672-2258

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1390 University Ave W
Saint Paul, MN 55104
Phone (651) 232-4800

2945 Hazelwood St
Ste 100
Saint Paul, MN 55109
Phone (651) 232-7800

1875 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Interoperability endpoints

  • Direct secure messaging: dsamson490040@fairview.direct-ci.com

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1689627606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13966 REDWOOD ST NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553044135",
            "telephone_number": "630-334-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W 98TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554204773",
            "telephone_number": "952-885-6150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1324 N Sheridan Rd",
            "address_purpose": "LOCATION",
            "city": "Waukegan",
            "state": "IL",
            "postal_code": "600852161",
            "country_code": "US",
            "telephone_number": "630-334-0968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMSON",
        "first_name": "DIANE",
        "middle_name": "K.",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-001315",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.