Daniel M Lillquist, P.A.
Individual provider Active NPI Physician Assistant · Bagley, MN
NPI 1700895604 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1700895604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9572 (MN)
- Practice address
- 1656 Central St W
Bagley, MN 56621-4357 - Phone
- (218) 694-2384
- NPI assigned
- Aug 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050329000484 | MN | Practitioner - Physician Assistant | 6002862455 | Reassigns benefits to 1 organization |
| I20081120000271 | TX | Practitioner - Physician Assistant | 6002862455 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9572 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Health of Northern Minnesota | Current |
Accepting new patients | |
| Centracare Health-Paynesville LLC | Past | Accepting new patients |
Locations
1656 Central St W
Bagley, MN 56621
Phone (218) 694-2384
1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9572 | MN | Yes |
Addresses
Primary practice location
1656 Central St W
Bagley, MN 56621-4357
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Other practice location 1
425 7th St NW
Cass Lake, MN 56633-3360
Phone (218) 335-3200
Other providers in Bagley, MN
- Melissa Nicole Jenson
- Mary Elizabeth Jones
- Klettenberg Chiropractic PLLC
- Logan Klettenberg
- Kim Louise Lavine
- Mississippi Headwaters Area Dental Health Center, Inc.
- Robin Motz
- Karley Neeland
- Jill Sandwick Nelson
- Barbara Neujahr
All providers in Bagley, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.