NPIMap

Individual provider Active NPI

Mary L Wangen, PA

  • Physician Assistant
  • Roseville, MN
National Provider Identifier
1760716310
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10887 Issued in MN
Practice address
2355 Highway 36 W Ste 100
Roseville, MN 55113-3905
Phone
(651) 292-2000
NPI assigned
Sep 30, 2009
Last updated
Jul 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10887 MN Primary

Addresses

Primary practice location

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905

Mailing address

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905
Phone (651) 292-2000

Other practice location 1

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Other practice location 2

9055 Springbrook Dr NW
Coon Rapids, MN 55433-5841
Phone (763) 780-9155

Other practice location 3

4801 W 81st St Ste 108
Bloomington, MN 55437
Phone (952) 837-9700

Other practice location 4

250 Thompson St
Saint Paul, MN 55102-2370
Phone (651) 292-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110415000560 MN Practitioner - Physician Assistant 8123166014 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321

PO Box
Minneapolis, MN 55440-0043

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.17 of 100Reported as group
Quality
95
Improvement activities
40
Cost
82.21

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Nov 6, 2023 Accepting new patients
Fairview Clinics CurrentSince Nov 6, 2023 Accepting new patients
Fairview Express Care CurrentSince Nov 6, 2023 Accepting new patients
Carris Health - Redwood LLC CurrentSince Jan 1, 2019 Accepting new patients
Allina Health System CurrentSince Nov 6, 2023 Accepting new patients
Carris Health - Redwood LLC CurrentSince Jan 1, 2019 Accepting new patients
Fairview Clinics CurrentSince Nov 6, 2023 Accepting new patients
Redwood Area Hospital Current Accepting new patients
Fairview Health Services CurrentSince Nov 6, 2023 Accepting new patients
Fairview Health Services CurrentSince Nov 6, 2023 Accepting new patients
Fairview Express Care CurrentSince Nov 6, 2023 Accepting new patients
Allina Health System CurrentSince Nov 6, 2023 Accepting new patients
NPI 1083910871 Past Accepting new patients
Regina Medical Center Past Accepting new patients
Consulting Radiologists, LTD Past Accepting new patients
Ecc Addiction & Toxicology Services LLC Past Accepting new patients
Affilion LLC Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

1175 Nininger Rd
Hastings, MN 55033
Phone (651) 404-1000

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

101 Caring Way
Redwood Falls, MN 56283
Phone (507) 637-2911

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

1400 N Acres Rd
Ste 30
Prescott, WI 54021
Phone (651) 437-3121

Interoperability endpoints

  • Direct secure messaging: mwangen1281@excellian.direct.allina.com

Organizations & group practices 26

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.

View all 26

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1760716310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9055 Springbrook Dr NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335841",
            "country_code": "US",
            "telephone_number": "763-780-9155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4801 W 81st St Ste 108",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "55437",
            "country_code": "US",
            "telephone_number": "952-837-9700",
            "fax_number": "952-837-9701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Thompson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022370",
            "country_code": "US",
            "telephone_number": "651-292-2000",
            "fax_number": "651-292-2136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANGEN",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-30",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.