Individual provider Active NPI

Britney Ann Gorman, PA-C

  • Physician Assistant
  • Blaine, MN
National Provider Identifier
1861976904
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13349 Issued in MN
Practice address
11225 Ulysses St NE
Blaine, MN 55434-4261
Phone
(763) 302-2600
Fax
(763) 302-2601
NPI assigned
Sep 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-006752 IL
Physician Assistant 363A00000X 13349 MN Primary

Addresses

Primary practice location

11225 Ulysses St NE
Blaine, MN 55434-4261

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

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
I20220210001572 MN Practitioner - Physician Assistant 2961755475

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-006752ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA Past Accepting new patients
Infinite Health Collaborative, PA 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": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1861976904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11225 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344261",
            "telephone_number": "763-302-2600",
            "fax_number": "763-302-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "BRITNEY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-006752",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.