Mio Watanabe, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0794 Issued in ND

Practice address

3674 S Washington St
Grand Forks, ND 58201-5766

Phone

(701) 205-3000

Fax

(701) 732-2501

NPI assigned

Dec 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in UT, AK, MN, ND, TX, MT6 enrollments

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 6

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Peterson Medical Clinics LLCGroup PAC ID 9335412220, 91 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Peterson Medical Clinics, LLC

  • Multi-Specialty Clinic/Center
  • Grand Forks, ND
  • NPI 1699295774

  AK, MN, MT, UT

  Medicare reassignment Care Compare group
• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1154358232

  Physician Assistant

  Medicare reassignment NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Aleknagik North, AK
  • NPI 1235291246

  TX

  Medicare reassignment
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Koliganek, AK
  • NPI 1013079607
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Ekwok, AK
  • NPI 1104988799
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Pilot Point, AK
  • NPI 1174683825
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Platinum, AK
  • NPI 1285796870
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Levelock, AK
  • NPI 1366502767
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • South Naknek, AK
  • NPI 1417018193
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Twin Hills, AK
  • NPI 1487716825
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Perryville, AK
  • NPI 1528128782
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Chignik Lagoon, AK
  • NPI 1578623641
  NPD

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1730695412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5210",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582065210",
            "telephone_number": "701-205-3000",
            "fax_number": "701-732-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3674 S WASHINGTON ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015766",
            "telephone_number": "701-205-3000",
            "fax_number": "701-732-2501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "672 W 400 S # B201",
            "address_purpose": "LOCATION",
            "city": "Springville",
            "state": "UT",
            "postal_code": "846633157",
            "country_code": "US",
            "telephone_number": "801-369-8989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "MIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-18",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "105968801206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13106",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0794",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "141585",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1693549",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730695412",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1478025",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Waryaa Services LLC
• Kaylee Rae Washburn-Mutscher
• Greg James Washburn
• Heather Wasness, PHARMD
• Travis Waswick, MD
• Jeanne Waterman
• April Waters, MOTR/L
• Malva F Waters, PH.D.
• Darcy Diane Watts, LSW
• Jinell S Wavra, OTR L

• Physician Assistant in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; 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.