Individual provider Active NPI

Rebecca Lynn Knutson, PA

  • Physician Assistant
  • Stillwater, MN
National Provider Identifier
1780904045
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1415 Issued in MN
Practice address
1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone
(651) 439-1234
NPI assigned
Jun 9, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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 1415 MN Primary

Addresses

Primary practice location

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040

Mailing address

8170 33Rd Ave So
Mail Stop 21110Q
Minneapolis, MN 55440-1309
Phone (952) 883-5463

Other names 1

  • Rebecca Ballandby Former name

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
I20101008000398 MN Practitioner - Physician Assistant 0547452518 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10747MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Jan 1, 2016 Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2500 Como Ave
Saint Paul, MN 55108
Phone (651) 641-6200

1500 Curve Crest Blvd W
Stillwater, MN 55082

921 Greeley St S
West Lakeland, MN 55082

Interoperability endpoints

  • Direct secure messaging: rknutson94862@direct.healthpartners.com

Organizations & group practices 2

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": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445385600000",
    "number": "1780904045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE SO",
            "address_2": "MAIL STOP 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554401309",
            "telephone_number": "952-883-5463",
            "fax_number": "952-853-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CURVE CREST BLVD W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826040",
            "telephone_number": "651-439-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUTSON",
        "first_name": "REBECCA",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-09",
        "last_updated": "2015-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "BALLANDBY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.