Riley Ostertag, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

11694 Issued in MN

Practice address

2330 Sioux TRL NW
Prior Lake, MN 55372-9077

Phone

(952) 496-6150

Fax

(952) 233-4224

NPI assigned

Oct 22, 2014

Last updated

Jul 22, 2015By 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

Other names 1

• Riley Blythe Former name

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, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Shakopee Mdewakanton Sioux Community

  dba Shakopee Dakota Clinic

  • Family Medicine Physician
  • Prior Lake, MN
  • NPI 1013933381
  Medicare reassignment

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1801290614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SIOUX TRL NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729077",
            "telephone_number": "952-496-6150",
            "fax_number": "952-233-4224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 SIOUX TRL NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729077",
            "telephone_number": "952-496-6150",
            "fax_number": "952-233-4224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSTERTAG",
        "first_name": "RILEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-22",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "11694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RILEY",
            "last_name": "BLYTHE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Faiza A Omar
• Amy Lynn Onson, RN, IBCLC, PHN
• Optage Inc (McKenna Crossing)
• Optimal Health LLC
• Orthodontic Care Group (Orthodontic Care Specialists)
• Paradise Valley Hospice Inc
• Park Nicollet Health Care Products
• Andrew Parker
• Pathways Chiropractic Health Center of Prior Lake, PA
• Carina Patnode, DC

• Medical Physician Assistant in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; 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.