Individual provider Active NPI

Mary C Aschenbrener, PA-C

  • Surgical Physician Assistant
  • Woodbury, MN
National Provider Identifier
1720057334
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
9376 Issued in MN
Practice address
215 Radio Dr Ste 100
Woodbury, MN 55125-5817
Phone
(612) 596-6187
NPI assigned
Mar 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 9376 MN Primary

Addresses

Primary practice location

215 Radio Dr Ste 100
Woodbury, MN 55125-5817

Mailing address

215 Radio Dr Ste 100
Woodbury, MN 55125-5817
Phone (612) 596-6187

Other identifiers 1

IdentifierTypeStateIssuer
195188200MedicaidMN

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
I20040304000991 MN Practitioner - Physician Assistant 7517855349 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9376MNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shriners Hospitals for Children CurrentSince Dec 1, 2018 Accepting new patients
Shriners Hospitals for Children CurrentSince Dec 1, 2018 Accepting new patients
Shriners Hospitals for Children Past Accepting new patients

Locations

2025 E River Rd
Minneapolis, MN 55414
Phone (612) 301-0115

215 Radio Dr
Ste 100
Woodbury, MN 55125
Phone (612) 596-6100

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1720057334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255817",
            "telephone_number": "612-596-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255817",
            "telephone_number": "612-596-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASCHENBRENER",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "9376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195188200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.