Kimberly Dawn Bleasdale, PA-C
Individual provider Active NPI Physician Assistant · New Hope, MN
NPI 1790787745 · NPPES record last updated May 18, 2015
Key facts
- NPI
- 1790787745
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10493 (MN)
- Practice address
- 8301 47TH Ave N
New Hope, MN 55428-4512 - Phone
- (763) 504-4935
- Fax
- (763) 504-4932
- NPI assigned
- Jun 2, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Park Nicollet Clinic
Practice addresses (Care Compare)
15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440
3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone (952) 993-3123
5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090402000375 | MN | Practitioner - Physician Assistant | 8820995251 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | Current |
Accepting new patients | |
| Park Nicollet Clinic | Current |
Accepting new patients | |
| Group Health, Inc. | Current |
Accepting new patients | |
| Park Nicollet Methodist Hospital | Current |
Accepting new patients | |
| Group Health, Inc. | Past | Accepting new patients |
Locations
1654 Diffley Rd
Ste 100
Eagan, MN 55122
Phone (651) 456-8670
8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600
2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
15290 Pennock Ln
Saint Paul, MN 55124
Phone (952) 431-8500
3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775
3931 Louisiana Ave S
St Louis Park, MN 55426
Phone (952) 993-3230
8450 Seasons Pkwy
Stop 32900A
Woodbury, MN 55125
Phone (651) 702-5300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10493 | MN | Yes |
Addresses
Primary practice location
8301 47TH Ave N
New Hope, MN 55428-4512
Mailing address
8301 47TH Ave N
New Hope, MN 55428-4512
Phone (763) 504-4935
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810000864 | Medicaid | WV |
Other names
- Miss Kimberly Dawn Petryszyn
Other providers in New Hope, MN
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- Stephanie Lynn Bischoff
- Marina Bluvshtein
- Arthur Bogdanove
- Stephen Piper Boger
- Shadlyn Cox Bourne
- Joan Boyd
All providers in New Hope, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.