Active NPI
Jerome D Phaff, PA
- Physician Assistant
- Minneapolis, MN
National Provider Identifier
1821196460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10758
- Practice address
- 4225 Golden Valley Road
Minneapolis, MN 55422-4215 - Phone
- (763) 588-0661
- Fax
- (763) 302-4218
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10758 | MN | Primary |
Addresses
Primary practice location
4225 Golden Valley Road
Minneapolis, MN 55422-4215
Mailing address
4225 Golden Valley Road
Minneapolis, MN 55422-4215
Phone (763) 588-0661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10758 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564531200000",
"number": "1821196460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4225 GOLDEN VALLEY ROAD",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554224215",
"telephone_number": "763-588-0661",
"fax_number": "763-302-4218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4225 GOLDEN VALLEY ROAD",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554224215",
"telephone_number": "763-588-0661",
"fax_number": "763-302-4218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAFF",
"first_name": "JEROME",
"middle_name": "D",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2019-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "10758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.