NPIMap

Individual provider Active NPI

Luke A. Herdina, P.A.-C

  • Medical Physician Assistant
  • Big Lake, MN
National Provider Identifier
1720118912
Registry record updated May 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1259 Issued in MN
Practice address
16830 198TH Ave NW
Big Lake Clinic
Big Lake, MN 55309
Phone
(763) 263-7300
NPI assigned
Mar 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0630 SD
Medical Physician Assistant 363AM0700X 1259 MN Primary

Addresses

Primary practice location

16830 198TH Ave NW
Big Lake Clinic
Big Lake, MN 55309

Mailing address

P.O. Box 539
16830 198TH Ave NW Big Lake Clinic
Big Lake, MN 55309
Phone (763) 263-7300

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
I20090716000336 MN Practitioner - Physician Assistant 8022112069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1900 Centracare Cir
Saint Cloud, MN 56303-5000

PO Box
Chicago, IL 60673

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1316NEMDMental Health Counselor
0630SDMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Jul 1, 2013 Accepting new patients
Centracare Clinic CurrentSince Jul 1, 2013 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

12800 Rolling Ridge Rd
Becker, MN 55308
Phone (763) 261-7000

16830 198th Ave NW
Big Lake, MN 55309
Phone (763) 263-7300

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: lherdina12148@direct.centracare.com

Organizations & group practices 5

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": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241481600000",
    "number": "1720118912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 539",
            "address_2": "16830 198TH AVE NW BIG LAKE CLINIC",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "55309",
            "telephone_number": "763-263-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16830 198TH AVE NW",
            "address_2": "BIG LAKE CLINIC",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "55309",
            "telephone_number": "763-263-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERDINA",
        "first_name": "LUKE",
        "middle_name": "A.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2009-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "0630",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "1259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Big Lake, MN

Sources for this page

Verify at the official NPI Registry.