NPIMap

Individual provider Active NPI

Molly Elizabeth Kozlowski, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1942535109
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1090341 Issued in MN
Practice address
1611 W. Harrison St
Ste #400 Midwest Orthopaedics at Rush, LLC
Chicago, IL 60612
Phone
(312) 243-4244
Fax
(312) 942-1517
NPI assigned
Oct 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 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 1090341 MN Primary
Surgical Physician Assistant 363AS0400X 085003614 IL

Addresses

Primary practice location

1611 W. Harrison St
Ste #400 Midwest Orthopaedics at Rush, LLC
Chicago, IL 60612

Mailing address

4480 Centerville Rd
White Bear Lake, MN 55127-3674
Phone (651) 484-2724

Other names 1

  • Molly Elizabeth Herrmann Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170620000113 CO Practitioner - Physician Assistant 8022155605
I20210128000671 MN Practitioner - Physician Assistant 8022155605 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

111 Hundertmark Rd
Suite 115N
Chaska, MN 55318-1584
Phone (952) 442-7820

560 S Maple St
Waconia, MN 55387-1757

7907 Powers Blvd
Chanhassen, MN 55317-9502
Phone (952) 934-0570

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1090341MNMDPhysician Assistant
085003614ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgeview Medical Center CurrentSince Jul 18, 2022 Accepting new patients
Advanced Dermatology Care Medical Cosmetic and Surgery PA CurrentSince Feb 16, 2021 Accepting new patients
Ridgeview Medical Center CurrentSince Jul 18, 2022 Accepting new patients
Major Hospital Past Accepting new patients
Center for Advanced Dermatology LLC PastSince Sep 1, 2024 Accepting new patients
Dermatology Inc Past Accepting new patients
Midwest Orthopaedics at Rush, LLC Past Accepting new patients

Locations

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

111 Hundertmark Rd
Ste 115N
Chaska, MN 55318
Phone (952) 361-2450

675 Water St
Excelsior, MN 55331
Phone (952) 906-7855

560 S Maple St
Ste 400
Waconia, MN 55387
Phone (952) 442-3188

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

4480 Centerville Rd
White Bear Lk, MN 55127
Phone (612) 550-1152

Organizations & group practices 8

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": "1254787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1942535109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551273674",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W. HARRISON ST",
            "address_2": "STE #400 MIDWEST ORTHOPAEDICS AT RUSH, LLC",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-243-4244",
            "fax_number": "312-942-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZLOWSKI",
        "first_name": "MOLLY",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-06",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1090341",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085003614",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "HERRMANN",
            "middle_name": "ELIZABETH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.