Mary L Janke, PA-C
Individual provider Active NPI Physician Assistant · Perham, MN
NPI 1831993799 · NPPES record last updated Jul 7, 2025
Key facts
- NPI
- 1831993799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 15417 (MN)
- Practice address
- 48859 428TH St
Perham, MN 56573-8821 - Phone
- (701) 219-3262
- NPI assigned
- Apr 1, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Astera Health
Practice addresses (Care Compare)
401 Douglas Ave
Henning, MN 56551-4026
Phone (218) 583-2953
415 Jefferson N St
Wadena, MN 56482-1264
415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7495
Hospital & facility affiliations
- Astera Health
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 |
|---|---|---|---|---|
| I20250919002801 | MN | Practitioner - Physician Assistant | 9537663745 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15417 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Astera Health | Current |
Accepting new patients | |
| Astera Health | Current |
Accepting new patients |
Locations
421 11th St NW
Wadena, MN 56482
Phone (218) 631-3510
415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510
Interoperability endpoints
- mjanke882448@direct.centracare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 15417 | MN | Yes |
Addresses
Primary practice location
48859 428TH St
Perham, MN 56573-8821
Mailing address
48859 428TH St
Perham, MN 56573-8821
Phone (701) 219-3262
Other providers in Perham, MN
- Ind School Dist 549
- Ind School Dist 549
- Integrity Counseling
- Winnie James
- Anna Ruth Janke
- Mylinda Johnson
- Shanaya Johnson
- Mikayla Jorgenson
- Peter Justnes
- Amanda Kannianen
All providers in Perham, 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 Jul 7, 2025. 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.