NPIMap

Individual provider Active NPI

Matthew Weiseman, PA-C

  • Physician Assistant
  • North Branch, MN
National Provider Identifier
1952885931
Registry record updated Dec 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5366 386TH St NE
North Branch, MN 55056-5833
Phone
(651) 674-8353
NPI assigned
Sep 17, 2018
Last updated
Dec 5, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2019

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

5366 386TH St NE
North Branch, MN 55056-5833

Mailing address

2930 11TH Ave
Evans, CO 80620-1011
Phone (970) 350-4606

Other practice location 1

2930 11th Ave
Evans, CO 80620-1011
Phone (970) 350-4606

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
I20200206000643 MN Practitioner - Physician Assistant 8224382353 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
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

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13119MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Dec 30, 2019 Accepting new patients
Fairview Clinics CurrentSince Oct 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Dec 30, 2019 Accepting new patients
Fairview Clinics CurrentSince Oct 1, 2020 Accepting new patients
Fairview Clinics 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

10961 Club West Pkwy
Minneapolis, MN 55449
Phone (763) 572-5700

2450 Riverside Ave
Fl 12
Minneapolis, MN 55454
Phone (612) 273-5000

400 Stinson Blvd
Minneapolis, MN 55413
Phone (612) 672-2258

5366 386th St NE
North Branch, MN 55056
Phone (651) 674-6800

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

Interoperability endpoints

  • Direct secure messaging: mweiseman331613@fairview.direct-ci.com

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

Hospital & facility affiliations 4

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": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575504000000",
    "number": "1952885931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-350-4606",
            "fax_number": "970-350-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 386TH ST NE",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550565833",
            "telephone_number": "651-674-8353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2930 11th Ave",
            "address_purpose": "LOCATION",
            "city": "Evans",
            "state": "CO",
            "postal_code": "806201011",
            "country_code": "US",
            "telephone_number": "970-350-4606",
            "fax_number": "970-350-4645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEISEMAN",
        "first_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-17",
        "last_updated": "2019-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Branch, MN

Sources for this page

Verify at the official NPI Registry.