NPIMap

Individual provider Active NPI

Desiree Deanovic, PA-C

  • Physician Assistant
  • Faribault, MN
National Provider Identifier
1932871910
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13767 Issued in MN
Practice address
300 State Ave
Faribault, MN 55021-6319
Phone
(507) 333-3300
NPI assigned
Sep 29, 2021
Last updated
Oct 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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 13767 MN Primary
Internal Medicine Physician 207R00000X 13767 MN

Addresses

Primary practice location

300 State Ave
Faribault, MN 55021-6319

Mailing address

2640 86TH CT W
Northfield, MN 55057-4234
Phone (952) 456-2042

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ddeanovic1341317@ehrdirect.mayoclinicmsg.org

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
I20211015000739 MN Practitioner - Physician Assistant 3971901349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

200 1St SWST
Rochester, MN 55905-0001

2200 NW 26TH St
Owatonna, MN 55060-5503
Phone (507) 451-1120

2250 NW 26TH St
Owatonna, MN 55060-5503
Phone (507) 451-3850

300 State Ave
Faribault, MN 55021-6319
Phone (507) 333-3300

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (507) 373-2384

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Oct 25, 2021 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Oct 25, 2021 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

300 State Ave
Faribault, MN 55021
Phone (507) 333-3300

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: ddeanovic1341317@ehrdirect.mayoclinicmsg.org

Organizations & group practices 3

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 12

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": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1932871910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 86TH CT W",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550574234",
            "telephone_number": "952-456-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 STATE AVE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550216319",
            "telephone_number": "507-333-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEANOVIC",
        "first_name": "DESIREE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13767",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "13767",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ddeanovic1341317@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "300 State Ave",
            "city": "Faribault",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550216319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.