Individual provider Active NPI

Jennifer C Durst, PA

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1861428385
Registry record updated Feb 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9383 Issued in MN
Practice address
1020 Bandana Blvd W
Saint Paul, MN 55108-5107
Phone
(651) 641-7000
Fax
(651) 641-7166
NPI assigned
Jun 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2020

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 9383 MN Primary

Addresses

Primary practice location

1020 Bandana Blvd W
Saint Paul, MN 55108-5107

Mailing address

2009 Tremont Ave
Fort Worth, TX 76107-3959
Phone (651) 642-2700

Other identifiers 1

IdentifierTypeStateIssuer
151628100MedicaidMN

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

LicenseStateTypeSpecialty
9383MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Past Accepting new patients
Sibley Medical Center Past Accepting new patients

Organizations & group practices 2

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": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1861428385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 TREMONT AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761073959",
            "telephone_number": "651-642-2700",
            "fax_number": "651-642-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 BANDANA BLVD W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085107",
            "telephone_number": "651-641-7000",
            "fax_number": "651-641-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURST",
        "first_name": "JENNIFER",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151628100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.