NPIMap

Individual provider Active NPI

Samantha Mantz

  • Physician Assistant
  • Coon Rapids, MN
National Provider Identifier
1902217045
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4040 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-4568
Phone
(763) 427-9980
Fax
(763) 427-0904
NPI assigned
May 12, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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 Primary

Addresses

Primary practice location

4040 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-4568

Mailing address

4040 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-4568
Phone (763) 427-9980

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smantz87602@excellian.direct.allina.com Direct

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
I20140708000569 MN Practitioner - Physician Assistant 3678798675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

PO Box
Minneapolis, MN 55440-0043

Hospital & facility affiliations

  • Mercy Hospital Hospital, Coon Rapids, MN, CCN 240115

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2075MNMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Jun 14, 2021 Accepting new patients
Allina Health System CurrentSince Jul 1, 2014 Accepting new patients
Allina Health System CurrentSince Jul 1, 2014 Accepting new patients
Fairview Express Care CurrentSince Jun 14, 2021 Accepting new patients
Allina Health System Past Accepting new patients

Locations

303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

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

4040 Coon Rapids Blvd NW
Ste 120
Minneapolis, MN 55433
Phone (763) 427-9980

1601 Saint Francis Ave
Ste 100
Shakopee, MN 55379
Phone (952) 403-3535

Interoperability endpoints

  • Direct secure messaging: smantz87602@excellian.direct.allina.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1902217045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334568",
            "telephone_number": "763-427-9980",
            "fax_number": "763-427-0904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334568",
            "telephone_number": "763-427-9980",
            "fax_number": "763-427-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTZ",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-12",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smantz87602@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "4040 Coon Rapids Blvd NW Ste 120",
            "city": "Coon Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554334568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.