Jenifer Karen Detert, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9545 Issued in MN

Practice address

Central Minnesota Emergency Physicians
1406 6TH Avenue North
St Cloud, MN 56303-1901

Phone

(320) 255-5656

Fax

(320) 656-7044

NPI assigned

Jan 9, 2007

Last updated

Aug 28, 2007By the provider in NPPES

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

Other names 1

• Ms. Jenifer Karen Vettleson Former name

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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centracare - Paynesville Hospital Hospital, Paynesville, MN, CCN 241349
• Centracare Health System - Melrose Hospital Hospital, Melrose, MN, CCN 241330
• Centracare Health System - Sauk Centre Hospital, Sauk Centre, MN, CCN 241368

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/glac-1755385c
• Direct secure messaging: jdetert1019@direct.centracare.com

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.

• Centracare Clinic

  dba CentraCare - River Campus Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1043212665
  Medicare reassignment Care Compare group
• Centracare Health System - Long Prairie

  • Critical Access Hospital
  • Long Prairie, MN
  • NPI 1164471678
  Medicare reassignment NPD
• Centracare Health System-NR LLC

  dba CentraCare Health - Monticello Hospital

  • Critical Access Hospital
  • Monticello, MN
  • NPI 1275872772
  Medicare reassignment NPD
• Centracare Health-Paynesville LLC

  dba CentraCare Health - Paynesville Hospital

  • Critical Access Hospital
  • Paynesville, MN
  • NPI 1205269941
  Medicare reassignment NPD
• Winona Health Services

  • General Acute Care Hospital
  • Winona, MN
  • NPI 1295789352
  Medicare reassignment NPD
• Centracare Health System - Melrose

  dba CentraCare Health - Melrose Hospital

  • Critical Access Hospital
  • Melrose, MN
  • NPI 1720045073
  Medicare reassignment
• Centracare Health System-NR LLC

  dba CentraCare - Monticello Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1558600874
  Medicare reassignment
• Centracare Health-Paynesville LLC

  dba CentraCare Health - Paynesville Clinic

  • Rural Health Clinic/Center
  • Paynesville, MN
  • NPI 1629402516
  Medicare reassignment
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Glacial Ridge Hospital District

  dba Brooten Medical Center

  • Family Medicine Physician
  • Brooten, MN
  • NPI 1255348223
  Medicare reassignment
• Welia Health

  • Critical Access Hospital
  • Mora, MN
  • NPI 1528031390
  Medicare reassignment
• Centracare Clinic

  dba CentraCare - Coordinated Care Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1003339789
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Centracare Health System - Melrose

  dba CentraCare Health - Melrose Hospital

  • Critical Access Hospital
  • Melrose, MN
  • NPI 1720045073
  Care Compare affiliation
• Centracare Health System - Melrose

  dba CentraCare Health - Melrose Clinic

  • Rural Health Clinic/Center
  • Melrose, MN
  • NPI 1730407586

  Hospital

  Care Compare affiliation
• Centracare Health System - Sauk Centre

  • Critical Access Hospital
  • Sauk Centre, MN
  • NPI 1740553932
  Care Compare affiliation
• Centracare Health-Paynesville LLC

  dba CentraCare Health - Paynesville Hospital

  • Critical Access Hospital
  • Paynesville, MN
  • NPI 1205269941
  Care Compare affiliation

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188259200000",
    "number": "1689723629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9808 JENNY LN",
            "city": "SAINT JOSEPH",
            "state": "MN",
            "postal_code": "563749692",
            "telephone_number": "320-363-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CENTRAL MINNESOTA EMERGENCY PHYSICIANS",
            "address_2": "1406 6TH AVENUE NORTH",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563031901",
            "telephone_number": "320-255-5656",
            "fax_number": "320-656-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETERT",
        "first_name": "JENIFER",
        "middle_name": "KAREN",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE REGISTRATION NUMBER",
            "identifier": "9545",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENIFER",
            "last_name": "VETTLESON",
            "middle_name": "KAREN",
            "prefix": "MS.",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey James Derr, MD
• Eduardo Pasion Desanto, M.D.
• Kylie Danielle Deschane
• Anne Elizabeth Deters, RN
• Anne Elizabeth Deters, LPCC
• Sindhu M. Devani, MD
• Developmental Impact LLC
• Sara Devos
• Sara Dezell, R.N.
• Gati Niranjan Dhroove, MBBS

• Physician Assistant in Saint Cloud, MN
• Providers in Saint Cloud, 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 28, 2007; 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.