Jaci Rae Hannasch, CNP
Individual provider Active NPI Nurse Practitioner · Marshall, MN
NPI 1760140180 · NPPES record last updated Jan 3, 2022
Key facts
- NPI
- 1760140180
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 8803 (MN)
- Practice address
- 300 S Bruce St
Marshall, MN 56258-1934 - Phone
- (507) 532-9661
- NPI assigned
- Dec 2, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avera Marshall
Practice addresses (Care Compare)
300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 537-9165
Hospital & facility affiliations
- Avera Marshall Regional Medical Ctr
- Avera Granite Falls
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220111002390 | MN | Practitioner - Nurse Practitioner | 8224420849 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8803 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Past | Accepting new patients | |
| Granite Falls Municipal Hospital and Manor | Past | Accepting new patients |
Locations
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 8803 | MN | Yes |
Addresses
Primary practice location
300 S Bruce St
Marshall, MN 56258-1934
Mailing address
507 Mercedes Dr
Marshall, MN 56258-5497
Phone (605) 360-6046
Other names
- Jaci Rae Pronk
Other providers in Marshall, MN
- Gloria Haag
- Jennifer Haedrich
- Mary Arndt Hagan
- Dana A Hamilton
- Elizabeth Lynn Hankermeyer
- Austin Ray Hansen
- Benjamin Larry Hanson
- Karissa J Hanson
- Bridgit Harris
- Donna Rae Hartfiel
All providers in Marshall, MN · Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.