Individual provider Active NPI

Mary L Janke, PA-C

  • Physician Assistant
  • Perham, MN
National Provider Identifier
1831993799
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15417 Issued in MN
Practice address
48859 428TH St
Perham, MN 56573-8821
Phone
(701) 219-3262
NPI assigned
Apr 1, 2025
Last updated
Jul 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 15417 MN Primary

Addresses

Primary practice location

48859 428TH St
Perham, MN 56573-8821

Mailing address

48859 428TH St
Perham, MN 56573-8821
Phone (701) 219-3262

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
I20250919002801 MN Practitioner - Physician Assistant 9537663745 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Astera HealthGroup PAC ID 2961395272, 106 clinicians

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15417MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Astera Health CurrentSince Sep 1, 2025 Accepting new patients
Astera Health CurrentSince Sep 1, 2025 Accepting new patients

Locations

415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510

421 11th St NW
Wadena, MN 56482
Phone (218) 631-3510

Interoperability endpoints

  • Direct secure messaging: mjanke882448@direct.centracare.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1743465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1831993799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48859 428TH ST",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565738821",
            "telephone_number": "701-219-3262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48859 428TH ST",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565738821",
            "telephone_number": "701-219-3262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANKE",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-01",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perham, MN

Sources for this page

Verify at the official NPI Registry.