NPIMap

Individual provider Active NPI

Stephanie Lynn Martin, PA-C

  • Physician Assistant
  • Eagan, MN
National Provider Identifier
1790340552
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13826 Issued in MN
Practice address
1185 Town Centre Dr Ste 205
Eagan, MN 55123-1370
Phone
(612) 871-1145
NPI assigned
May 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4669-23 WI
Physician Assistant 363A00000X 13826 MN Primary

Addresses

Primary practice location

1185 Town Centre Dr Ste 205
Eagan, MN 55123-1370

Mailing address

1185 Town Centre Dr Ste 205
Eagan, MN 55123-1370
Phone (612) 871-1145

Other identifiers 1

IdentifierTypeStateIssuer
1790340552MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190529002014 WI Practitioner - Physician Assistant 3274876586 Reassigns benefits to 1 organization
I20211123000920 MN Practitioner - Physician Assistant 3274876586 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

10150 Niagara LN N
Suite 210
Maple Grove, MN 55369-7588
Phone (612) 871-1145

1185 Town Centre Dr
Suite 200
Eagan, MN 55123-1343
Phone (612) 871-1145

15700 37TH Ave N
Plymouth, MN 55446-3399
Phone (612) 871-1145

15700 37TH Ave N
Suite 300
Plymouth, MN 55446-3661
Phone (612) 871-1145

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (612) 892-2121

3001 Broadway St NE
B700
Minneapolis, MN 55413-2195
Phone (612) 871-1145

3588 Arcade St
Suite 110
Vadnais Heights, MN 55127-7135
Phone (612) 871-1145

5705 W Old Shakopee Rd
Suite 150
Bloomington, MN 55437-3126
Phone (612) 871-1145

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-4633

9145 Springbrook Dr NW
Suite 300
Coon Rapids, MN 55433-5897
Phone (612) 871-1145

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: smartinmd309235@direct.froedtert.com
  • Direct secure messaging: stephanie.martinpac.p1@direct.mngastro.nextgenshare.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1790340552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 TOWN CENTRE DR STE 205",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231370",
            "telephone_number": "612-871-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 TOWN CENTRE DR STE 205",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231370",
            "telephone_number": "612-871-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4669-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790340552",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.