NPIMap

Individual provider Active NPI

Crystal Ann Waagmeester, PA

  • Medical Physician Assistant
  • East Gull Lake, MN
National Provider Identifier
1861798936
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
11309 Issued in MN
Practice address
3559 Shady Lane Cir
East Gull Lake, MN 56401-7940
Phone
(218) 234-3101
NPI assigned
Feb 7, 2011
Last updated
Oct 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 11309 MN Primary
Medical Physician Assistant 363AM0700X 3918-23 WI

Addresses

Primary practice location

3559 Shady Lane Cir
East Gull Lake, MN 56401-7940

Mailing address

3559 Shady Lane Cir
East Gull Lake, MN 56401-7940
Phone (218) 234-3101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180404002410 MN Practitioner - Physician Assistant 3577740398 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

2014 S 6TH St
Brainerd, MN 56401-4529
Phone (218) 829-7812

2024 S 6TH St
Brainerd, MN 56401-4529
Phone (218) 828-7100

301 2ND Ave NW
Staples, MN 56479-3336
Phone (218) 894-7870

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7394

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3918-23WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brainerd Medical Center Inc. CurrentSince Apr 30, 2018 Accepting new patients
St Joseph's Medical Center CurrentSince Apr 30, 2018 Accepting new patients
Brainerd Medical Center Inc CurrentSince Apr 30, 2018 Accepting new patients
St. Joseph's Medical Center CurrentSince Apr 30, 2018 Accepting new patients
St Joseph's Medical Center Past Accepting new patients

Locations

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

Organizations & group practices 7

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 11

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": "1297036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1861798936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3559 SHADY LANE CIR",
            "city": "EAST GULL LAKE",
            "state": "MN",
            "postal_code": "564017940",
            "telephone_number": "218-234-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3559 SHADY LANE CIR",
            "city": "EAST GULL LAKE",
            "state": "MN",
            "postal_code": "564017940",
            "telephone_number": "218-234-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAAGMEESTER",
        "first_name": "CRYSTAL",
        "middle_name": "ANN",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-07",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "11309",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3918-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Gull Lake, MN

Sources for this page

Verify at the official NPI Registry.