NPIMap

Individual provider Active NPI

Annali Mariucci

  • Physician Assistant
  • Golden Valley, MN
National Provider Identifier
1700413762
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1415 Lilac Dr N Ste 190
Golden Valley, MN 55422-4544
Phone
(763) 267-8701
NPI assigned
Mar 26, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1415 Lilac Dr N Ste 190
Golden Valley, MN 55422-4544

Mailing address

1415 Lilac Dr N Ste 190
Golden Valley, MN 55422-4544
Phone (218) 780-8581

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200521000301 MN Practitioner - Physician Assistant 2668803933 Reassigns benefits to 1 organization

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
Twin Cities Physicians Professional CorporationGroup PAC ID 9830499763, 66 clinicians

Practice addresses (Care Compare)

1415 Lilac Dr N
Suite 190
Golden Valley, MN 55422-4544
Phone (763) 267-8701

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.11 of 100Reported as group
Quality
70.97
Improvement activities
40
Cost
73.58

National Provider Directory

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

Organizations & group practices 1

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1700413762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 LILAC DR N STE 190",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224544",
            "telephone_number": "218-780-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 LILAC DR N STE 190",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224544",
            "telephone_number": "763-267-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIUCCI",
        "first_name": "ANNALI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

Verify at the official NPI Registry.