Individual provider Active NPI

Jeremiah Lynch, PA-C

  • Physician Assistant
  • Roseville, MN
National Provider Identifier
1811356397
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1835 County Road C W
Roseville, MN 55113-1352
Phone
(763) 785-4500
NPI assigned
Feb 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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 Primary

Addresses

Primary practice location

1835 County Road C W
Roseville, MN 55113-1352

Mailing address

1835 County Road C W
Roseville, MN 55113-1352
Phone (763) 785-4500

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
I20160331000000 MN Practitioner - Physician Assistant 7911204235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

2600 39TH Ave NE
Minneapolis, MN 55421-4379
Phone (651) 430-3800

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

4181 108TH Ave NE
Blaine, MN 55449-7439
Phone (651) 430-3800

4209 Webber Pkwy
Minneapolis, MN 55412-1747
Phone (763) 581-2273

480 Osborne Rd NE
Suite 100
Fridley, MN 55432-2781
Phone (763) 581-2273

800 Freeport Ave NW
Elk River, MN 55330-2723
Phone (763) 581-2273

9855 Hospital Dr
Maple Grove, MN 55369-4648

9875 Hospital Dr
Maple Grove, MN 55369-4648
Phone (763) 581-1000

Hospital & facility affiliations

  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12042MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince Jun 1, 2017 Accepting new patients
North Memorial Health Care CurrentSince Jun 1, 2017 Accepting new patients
North Memorial Health Care Past Accepting new patients

Locations

11855 Ulysses St NE
Ste 110
Blaine, MN 55434
Phone (763) 235-4104

800 Freeport Ave NW
Ste 100
Elk River, MN 55330
Phone (763) 581-5200

9855 Hospital Dr
Ste 102A
Maple Grove, MN 55369
Phone (763) 581-9220

480 Osborne Rd NE
Ste 100
Minneapolis, MN 55432
Phone (763) 785-4500

15450 Highway 7
Ste 100
Minnetonka, MN 55345
Phone (763) 581-8900

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

2600 39th Ave NE
Saint Anthony, MN 55421
Phone (612) 706-2690

Interoperability endpoints

  • Direct secure messaging: jlynch127928@direct.northmemorial.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1811356397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 COUNTY ROAD C W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131352",
            "telephone_number": "763-785-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 COUNTY ROAD C W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131352",
            "telephone_number": "763-785-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYNCH",
        "first_name": "JEREMIAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.