Individual provider Active NPI

Michele T Glood, PA C

  • Physician Assistant
  • Apple Valley, MN
National Provider Identifier
1851363956
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10012 Issued in MN
Practice address
15290 Pennock LN
Apple Valley, MN 55124-7163
Phone
(952) 853-8800
Fax
(952) 431-6966
NPI assigned
Feb 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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 10012 MN Primary

Addresses

Primary practice location

15290 Pennock LN
Apple Valley, MN 55124-7163

Mailing address

8170 33Rd Ave S # Ms 21110Q
Minneapolis, MN 55425-4516

Other identifiers 1

IdentifierTypeStateIssuer
42877600MedicaidWI

Other names 1

  • Michele Trach Former name

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
I20080923000793 MN Practitioner - Physician Assistant 8022038413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

8325 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5868

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5300

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10012MNMDDental Hygienist

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Jul 21, 2008 Accepting new patients
Group Health, Inc. CurrentSince Jul 21, 2008 Accepting new patients
Group Health, Inc. Past Accepting new patients

Locations

15350 English Ave
Apple Valley, MN 55124
Phone (952) 431-8500

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

15290 Pennock Ln
Saint Paul, MN 55124
Phone (952) 431-8500

2500 Como Ave
Saint Paul, MN 55108
Phone (651) 641-6200

205 Wabasha St S
Saint Paul, MN 55107
Phone (651) 293-8100

3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775

8450 Seasons Pkwy
Woodbury, MN 55125
Phone (651) 702-5300

403 Stageline Rd
Hudson, WI 54016
Phone (715) 386-8880

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.

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1851363956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15290 PENNOCK LN",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247163",
            "telephone_number": "952-853-8800",
            "fax_number": "952-431-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLOOD",
        "first_name": "MICHELE",
        "middle_name": "T",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42877600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELE",
            "last_name": "TRACH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Apple Valley, MN

Sources for this page

Verify at the official NPI Registry.