Nicole Renee Prosser, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9576 Issued in MN

Practice address

25945 Gateway Dr
Zimmerman, MN 55398-5300

Phone

(763) 856-6900

NPI assigned

May 12, 2006

Last updated

May 19, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Accentcare Fairview Home Health - West, LLC Home health agency, Saint Paul, MN, CCN 247078
• Fairview Northland Regional Hospital Hospital, Princeton, MN, CCN 240141

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nprosser8413@fairview.direct-ci.com

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.

• Fairview Clinics

  dba Fairview Clinics-Hiawatha

  • Primary Care Clinic/Center
  • Minneapolis, MN
  • NPI 1346432218
  Medicare reassignment Care Compare group
• Fairview Express Care

  dba M Health Fairview Recovery Clinic

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Fairview Clinics

  • Primary Care Clinic/Center
  • Saint Paul, MN
  • NPI 1396552147
  NPD
• Fairview Clinics

  • Multi-Specialty Clinic/Center
  • Brooklyn Park, MN
  • NPI 1679754998
  NPD
• Fairview Express Care

  dba Fairview Brooklyn Park Clinic (Eyewear)

  • Eyewear Supplier
  • Brooklyn Park, MN
  • NPI 1528241718
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Fairview Health Services

  dba Fairview Emergency Medical Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Fairview Health Services

  • Hospitalist Physician
  • Burnsville, MN
  • NPI 1952499444
  NPD
• Fairview Clinics

  dba Fairview Clinics-Maple Grove

  • Multi-Specialty Clinic/Center
  • Maple Grove, MN
  • NPI 1841315165
  NPD (past)

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

• Accentcare Fairview Home Health - West, LLC

  • Home Health Agency
  • Saint Paul, MN
  • NPI 1477169233
  Care Compare affiliation
• Fairview Health Services

  dba Fairview Diagnostic Laboratory

  • General Acute Care Hospital
  • Princeton, MN
  • NPI 1841351749
  Care Compare affiliation
• Fairview Health Services

  dba Fairview Northland Hospital

  • General Acute Care Hospital
  • Princeton, MN
  • NPI 1922085299
  Care Compare affiliation

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1780635003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25945 GATEWAY DR",
            "city": "ZIMMERMAN",
            "state": "MN",
            "postal_code": "553985300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25945 GATEWAY DR",
            "city": "ZIMMERMAN",
            "state": "MN",
            "postal_code": "553985300",
            "telephone_number": "763-856-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROSSER",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tyler Paul Roehl, D.C.
• Royalty Holistic Home Care

• Physician Assistant in Zimmerman, MN
• Providers in Zimmerman, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.