Individual provider Active NPI

Andrew William Wittchow, PA-C

  • Physician Assistant
  • Eden Prairie, MN
National Provider Identifier
1780054254
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15130 Issued in MN
Practice address
965 Prairie Center Dr Ste 200
Eden Prairie, MN 55344-3671
Phone
(952) 995-8780
NPI assigned
Sep 28, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

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 15130 MN Primary

Addresses

Primary practice location

965 Prairie Center Dr Ste 200
Eden Prairie, MN 55344-3671

Mailing address

3500 American Blvd W Ste 300
Bloomington, MN 55431-4442
Phone (952) 512-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250106000065 MN Practitioner - Physician Assistant 6507176948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

16800 37TH PL N
Plymouth, MN 55446-2805
Phone (763) 520-7870

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

4010 W 65TH St
Edina, MN 55435-1706
Phone (952) 456-7000

5601 96TH Ave N
Brooklyn Park, MN 55443-4505
Phone (763) 786-9543

820 Village Way
Waconia, MN 55387-4612

9630 Grove Cir N
Suite 200
Maple Grove, MN 55369-3492
Phone (763) 520-7870

965 Prairie Ctr Dr
Eden Prairie, MN 55344-3671

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Feb 3, 2025 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Feb 3, 2025 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

11225 Ulysses St NE
Blaine, MN 55434
Phone (763) 302-2600

1000 W 140th St
Unit 201
Burnsville, MN 55337
Phone (952) 808-3000

2700 Vikings Cir
Eagan, MN 55121
Phone (952) 456-7600

9630 Grove Cir N
Ste 200
Maple Grove, MN 55369
Phone (763) 520-7580

3500 American Blvd W
Ste 300
Minneapolis, MN 55431
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

4010 W 65th St
Minneapolis, MN 55435
Phone (952) 456-7000

16800 37th Pl N
#200
Plymouth, MN 55446
Phone (635) 207-8707

3545 Highway 61 N
Vadnais Heights, MN 55110

820 Village Way
#200
Waconia, MN 55387

4040 Radio Dr
Woodbury, MN 55129
Phone (514) 398-8076

Interoperability endpoints

  • Direct secure messaging: awittchow680247@direct.novanthealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1780054254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 AMERICAN BLVD W STE 300",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554314442",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 PRAIRIE CENTER DR STE 200",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443671",
            "telephone_number": "952-995-8780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTCHOW",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-28",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.