Active NPI
Gayle L Breutzman, PA
- Surgical Physician Assistant
- Minneapolis, MN
National Provider Identifier
1760588859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 9084
- Practice address
- 1 Veterans Dr
Dept of Surgery
Minneapolis, MN 55417-2309 - Phone
- (612) 725-2000
- Fax
- (612) 725-1920
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 9084 | MN | Primary |
Addresses
Primary practice location
1 Veterans Dr
Dept of Surgery
Minneapolis, MN 55417-2309
Mailing address
1 Veterans Dr
Dept of Surgery
Minneapolis, MN 55417-2309
Phone (612) 725-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9084 | MN | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760588859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 VETERANS DR",
"address_2": "DEPT OF SURGERY",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554172309",
"telephone_number": "612-725-2000",
"fax_number": "612-725-1920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 VETERANS DR",
"address_2": "DEPT OF SURGERY",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554172309",
"telephone_number": "612-725-2000",
"fax_number": "612-725-1920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREUTZMAN",
"first_name": "GAYLE",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MN",
"license": "9084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.