NPIMap

Individual provider Active NPI

Leah Nicole Agneberg, PA-C

  • Physician Assistant
  • Edina, MN
National Provider Identifier
1720547920
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12970 Issued in MN
Practice address
8100 W 78TH St Ste 230
Edina, MN 55439-2570
Phone
(952) 946-9777
NPI assigned
Mar 18, 2019
Last updated
Nov 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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 12970 MN Primary

Addresses

Primary practice location

8100 W 78TH St Ste 230
Edina, MN 55439-2570

Mailing address

8100 W 78TH St Ste 230
Edina, MN 55439-2570
Phone (952) 946-9777

Other practice location 1

225 Smith Ave N Ste 300
Saint Paul, MN 55102-2592
Phone (952) 946-9777

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lagneberg293113@excellian.direct.allina.com Direct

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
I20190501000654 MN Practitioner - Physician Assistant 5597007179 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 87 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

14655 Galaxie Ave
Apple Valley, MN 55124-8602

2925 Chicago Ave
Minneapolis, MN 55407-1321

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

8675 Valley Creek Rd
Woodbury, MN 55125-2337
Phone (651) 241-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12970MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Apr 22, 2019 Accepting new patients
Allina Health System CurrentSince Apr 22, 2019 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

8100 W 78th St
Ste 230
Minneapolis, MN 55439
Phone (952) 248-5970

225 Smith Ave N
Ste 300
Saint Paul, MN 55102
Phone (651) 241-5000

8675 Valley Creek Rd
Woodbury, MN 55125
Phone (651) 241-3000

Interoperability endpoints

  • Direct secure messaging: lagneberg293113@excellian.direct.allina.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1720547920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 W 78TH ST STE 230",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392570",
            "telephone_number": "952-946-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 W 78TH ST STE 230",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392570",
            "telephone_number": "952-946-9777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Smith Ave N Ste 300",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022592",
            "country_code": "US",
            "telephone_number": "952-946-9777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGNEBERG",
        "first_name": "LEAH",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-18",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lagneberg293113@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "225 Smith Ave N Ste 300",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551022592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.