Debra Kay Maas Bellingham, PA-C
Individual provider Active NPI Physician Assistant · Long Lake, MN
NPI 1760413397 · NPPES record last updated Mar 1, 2023
Key facts
- NPI
- 1760413397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9939 (MN)
- Practice address
- 148 Glendale Dr
Long Lake, MN 55356-9714 - Phone
- (952) 221-0781
- NPI assigned
- Jul 5, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|---|
| I20041223000039 | MN | Practitioner - Physician Assistant | 1850359746 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9939 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Current |
Accepting new patients |
Locations
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9939 | MN | Yes |
Addresses
Primary practice location
148 Glendale Dr
Long Lake, MN 55356-9714
Mailing address
148 Glendale Dr
Long Lake, MN 55356-9714
Phone (952) 221-0781
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 216924000 | Medicaid | MN |
Other names
- Debra Kay Maas
Other providers in Long Lake, MN
- A & O Health Group, LLC
- Align Health & Wellness PA
- Anna Barlage LMFT PLLC
- Danielle Baker
- Anna Katherine Barlage
- Anthony Walter Boe
- Centering Your Life Psychology PLLC
- Chirocenter Inc.
- Chiropractic First
- Kevin Connery
All providers in Long Lake, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2023. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.