Breanne Van de Bogart, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11186 Issued in MN

Practice address

701 Park Ave, R1
HCMC-Emergency Dept/Urgent Care
Minneapolis, MN 55414-1623

Phone

(612) 873-4342

NPI assigned

Aug 14, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Breanne Krogman Former name

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• North Memorial Health Care

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Medicare reassignment Care Compare group
• North Memorial Health Care

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1568893220
  NPD

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

{
    "created_epoch": "1344902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1730436296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE, R1",
            "address_2": "HCMC-EMERGENCY DEPT/URGENT CARE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141623",
            "telephone_number": "612-873-4342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE, R1",
            "address_2": "HCMC-EMERGENCY DEPT/URGENT CARE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141623",
            "telephone_number": "612-873-4342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE BOGART",
        "first_name": "BREANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-14",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNE",
            "last_name": "KROGMAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kjersti Olivia Van Bergen, NP
• Van Beusekom Enterprises
• Joan M Van Camp, MD
• Laura M Van Cleve, DO
• Laura Lee Van Dam
• Peter J Van de Walker
• Sophia Van de Werken, NONE
• Anna Grace Van Deelen, MD
• Haley Van Den Burg, MS, CCC-SLP
• Jane Katherine Van Deusen-Morrison, RN ACNS-BC

• Physician Assistant in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.