NPIMap

Individual provider Active NPI

Jennifer L Waite, PA-C

  • Physician Assistant
  • Maple Grove, MN
National Provider Identifier
1891070694
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13027 Issued in MN
Practice address
9825 Hospital Dr Ste 205
Maple Grove, MN 55369-4480
Phone
(763) 587-7000
Fax
(763) 587-7015
NPI assigned
Oct 12, 2011
Last updated
Sep 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 363AM0700X IL
Medical Physician Assistant 363AM0700X 085.004163 IL
Physician Assistant 363A00000X 13027 MN Primary

Addresses

Primary practice location

9825 Hospital Dr Ste 205
Maple Grove, MN 55369-4480

Mailing address

2001 Killebrew Dr
Ste 308
Bloomington, MN 55425-1886
Phone (651) 999-7022

Other practice location 1

675 N Saint Clair St Ste 15-200
Chicago, IL 60611-5967
Phone (408) 621-1354

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
I20191021001058 MN Practitioner - Physician Assistant 0446410757 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minnesota Urology, PAGroup PAC ID 0840183984, 83 clinicians

Practice addresses (Care Compare)

1185 Town Centre Dr
Eagan, MN 55123-1189
Phone (651) 999-6800

2855 Campus Dr
Suite 530
Plymouth, MN 55441-2660
Phone (651) 999-6800

3960 Coon Rapids Blvd NW
Suite 301
Coon Rapids, MN 55433-2598
Phone (651) 999-6800

500 Osborne Rd NE
Suite 120
Fridley, MN 55432-2767
Phone (651) 999-6800

6025 Lake Rd
Suite 200
Woodbury, MN 55125-1710
Phone (651) 999-6800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.84 of 100Reported as group
Quality
64.59
Promoting interoperability
100
Improvement activities
40
Cost
84.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
363AM0700XILMDPhysician Assistant
085.004163ILMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: jennifer.waite.1@20581.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 31

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1891070694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 KILLEBREW DR",
            "address_2": "STE 308",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251886",
            "telephone_number": "651-999-7022",
            "fax_number": "651-999-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9825 HOSPITAL DR STE 205",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694480",
            "telephone_number": "763-587-7000",
            "fax_number": "763-587-7015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 N Saint Clair St Ste 15-200",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606115967",
            "country_code": "US",
            "telephone_number": "408-621-1354",
            "fax_number": "312-695-4303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAITE",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-12",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "363AM0700X",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.004163",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.