Eliza Anderson Abraham, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

14153 Issued in MN

Practice address

4480 Centerville Rd
White Bear Lake, MN 55127

Phone

(651) 484-2724

Fax

(651) 484-2723

NPI assigned

Oct 12, 2021

Last updated

Oct 14, 2022By 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

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pinnacle Dermatology SCGroup PAC ID 8628353380, 145 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

74.85 of 100Reported as group

Quality

70.56

Promoting interoperability

81

Improvement activities

40

Cost

61.43

Merit-based Incentive Payment System (MIPS)

Final score

89.8 of 100Reported as group

Promoting interoperability

88

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: elizaa@adc.emadirect.md

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.

• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Joliet, IL
  • NPI 1861930984

  MN

  Medicare reassignment Care Compare group
• Advanced Dermatology Care Medical Cosmetic and Surgery PA

  dba Advanced Dermatology Care

  • Dermatology Physician
  • White Bear Lake, MN
  • NPI 1073614558
  Medicare reassignment NPD
• Advanced Dermatology Care Medical Cosmetic and Surgery PA

  dba Advanced Dermatology Care

  • Dermatology Physician
  • Forest Lake, MN
  • NPI 1912158031
  NPD
• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Plymouth, MN
  • NPI 1609009380
  NPD (past)

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1699437145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55127",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55127",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABRAHAM",
        "first_name": "ELIZA",
        "middle_name": "ANDERSON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-12",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "14153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN LICENSE",
            "identifier": "14153",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 3820 Hoffman Rd Opco LLC
• Aalfa Family Practice PA (AALFA Family Clinic)
• Abdifatah Hassan Abdi
• Allison Mari Ackerknecht
• Evelyn Jessie Acosta, RN, PHN
• Acupuncture Queen, LLC
• Advanced Acupuncture & Pain Management Clinic
• Advanced Dermatology Care Medical Cosmetic and Surgery PA (Advanced Dermatology Care)

• Medical Physician Assistant in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.