Individual provider Active NPI

Anna Raye Niesen, PA-C

  • Physician Assistant
  • Princeton, MN
National Provider Identifier
1891165692
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2350 Issued in MN
Practice address
919 Northland Dr
Princeton, MN 55371-2172
Phone
(763) 389-3344
NPI assigned
Oct 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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 2350 MN Primary

Addresses

Primary practice location

919 Northland Dr
Princeton, MN 55371-2172

Mailing address

1700 University Ave W FL 6
Saint Paul, MN 55104-3727

Other practice location 1

290 Main St NW Ste 100
Elk River, MN 55330-1251
Phone (763) 241-0373

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
I20151125000278 MN Practitioner - Physician Assistant 9638479504 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (952) 914-1732

290 Main St NW
Suite 100
Elk River, MN 55330-1251
Phone (763) 241-5800

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

  • Accentcare Fairview Home Health - West, LLC Home health agency, Saint Paul, MN, CCN 247078
  • Fairview Northland Regional Hospital Hospital, Princeton, MN, CCN 240141

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2350MNMDChiropractor
1965MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Oct 12, 2018 Accepting new patients
Fairview Clinics CurrentSince Oct 12, 2018 Accepting new patients
Fairview Express Care CurrentSince Jun 23, 2024 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Oct 12, 2018 Accepting new patients
Fairview Express Care CurrentSince Jun 23, 2024 Accepting new patients
Fairview Health Services CurrentSince Oct 12, 2018 Accepting new patients
Fairview Clinics Past Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

290 Main St NW
Ste 100
Elk River, MN 55330
Phone (763) 241-0373

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

919 Northland Dr
Princeton, MN 55371
Phone (763) 389-3344

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Interoperability endpoints

  • Direct secure messaging: aniesen453243@fairview.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 3

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": "1444089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1891165692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W FL 6",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712172",
            "telephone_number": "763-389-3344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 Main St NW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Elk River",
            "state": "MN",
            "postal_code": "553301251",
            "country_code": "US",
            "telephone_number": "763-241-0373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIESEN",
        "first_name": "ANNA",
        "middle_name": "RAYE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-06",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "2350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, MN

Sources for this page

Verify at the official NPI Registry.