Allyce Katherine Fisk, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

215 Radio Dr Ste 100
Woodbury, MN 55125-5817

Phone

(612) 596-6100

NPI assigned

Oct 16, 2012

Last updated

Feb 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Healtheast Medical Research Institute

  dba HealthEast Vadnais Heights Clinic

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  Medicare reassignment
• Shriners Hospitals for Children

  dba Shriners Children's

  • Rehabilitation Clinic/Center
  • Woodbury, MN
  • NPI 1285250977
  Medicare reassignment
• Healtheast Medical Research Institute

  dba M Health Fairview Specialty Clinic Beam

  • Clinic/Center
  • Maplewood, MN
  • NPI 1164154316
  NPD
• Healtheast Medical Research Institute

  dba HealthEast Professional Services

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552
  NPD
• Shriners Hospitals for Children

  dba Shriners Children's Hawaii

  • Clinic/Center
  • Aiea, HI
  • NPI 1568299857
  NPD
• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1568803732
  NPD (past)

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1730432709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 RADIO DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255815",
            "telephone_number": "612-596-6100"
        },
        {
            "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": "612-596-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2090 Woodwinds Dr",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551252522",
            "country_code": "US",
            "telephone_number": "651-968-5801",
            "fax_number": "651-968-5899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2025 E River Pkwy",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55414",
            "country_code": "US",
            "telephone_number": "612-596-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FISK",
        "first_name": "ALLYCE",
        "middle_name": "KATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-16",
        "last_updated": "2021-02-15",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11228",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Firm Bridge LLC
• Kimberly A Fischer, MD
• Laken M Fischer, NP
• Maren Fiscus
• Evan P Fisher
• Rachel Lynn Fisk
• Sara Fiskum, PHARM. D.
• Grace Fitch
• Taliana Nala Fitzgerald
• Five Star Alternative Care Nursing Co

• Surgical Physician Assistant in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Surgical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.