Active NPI
Michelle Manos, PA-C
- Physician Assistant
- Blaine, MN
National Provider Identifier
1760539746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9305
- Practice address
- 1500 109TH Ave NE
Blaine, MN 55449-4670 - Phone
- (763) 354-1000
- NPI assigned
- Jan 4, 2007
- Last updated
- Mar 28, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9305 | MN | Primary |
Addresses
Primary practice location
1500 109TH Ave NE
Blaine, MN 55449-4670
Mailing address
8462 Norway St NW
Coon Rapids, MN 55433-6065
Phone (763) 318-0641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9305 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Now Medical, Inc | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Organizations & group practices 1
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.
-
- Urgent Care Clinic/Center
- Maple Grove, MN
- NPI 1306993142
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1760539746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8462 NORWAY ST NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554336065",
"telephone_number": "763-318-0641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 109TH AVE NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554494670",
"telephone_number": "763-354-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANOS",
"first_name": "MICHELLE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "9305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.