Jacob Patrick Berwyn, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1001 Hart Blvd Ste 100
Monticello, MN 55362-8929

Phone

(763) 295-2921

NPI assigned

Sep 8, 2017

Last updated

Mar 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 3

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stellis Health, PAGroup PAC ID 1153233796, 54 clinicians

Centracare Health System-NR LLCGroup PAC ID 3870739410, 63 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Buffalo Hospital Hospital, Buffalo, MN, CCN 240076
• Centracare Health - Monticello Hospital, Monticello, MN, CCN 241362

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jberwyn566043@direct.centracare.com

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.

• Centracare Health System-NR LLC

  dba CentraCare - Monticello Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1558600874
  Medicare reassignment Care Compare group
• Stellis Health, PA

  dba Buffalo Clinic, Monticello Clinic, Albertville/St.Michael Clinic,

  • Multi-Specialty Clinic/Center
  • Buffalo, MN
  • NPI 1184664674
  Medicare reassignment Care Compare group
• Centracare Health System-NR LLC

  dba CentraCare Health - Monticello Hospital

  • Critical Access Hospital
  • Monticello, MN
  • NPI 1275872772
  NPD
• Centracare Health System-NR LLC

  dba CentraCare Health - Monticello Rehab Unit

  • Rehabilitation Hospital Unit
  • Monticello, MN
  • NPI 1821337148
  NPD
• Stellis Health, PA

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1013103050
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Allina Health System

  dba Buffalo Hospital

  • General Acute Care Hospital
  • Buffalo, MN
  • NPI 1538123567
  Care Compare affiliation
• Centracare Health System-NR LLC

  dba CentraCare Health - Monticello Hospital

  • Critical Access Hospital
  • Monticello, MN
  • NPI 1275872772
  Care Compare affiliation
• Centracare Health System-NR LLC

  dba CentraCare - Monticello Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1558600874

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1972021038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131930",
            "telephone_number": "763-682-1313",
            "fax_number": "763-581-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 HART BLVD STE 100",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628929",
            "telephone_number": "763-295-2921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11091 Jason Ave NE Ste 1",
            "address_purpose": "LOCATION",
            "city": "Albertville",
            "state": "MN",
            "postal_code": "553014703",
            "country_code": "US",
            "telephone_number": "763-684-8300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1700 Highway 25 N",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "MN",
            "postal_code": "553131930",
            "country_code": "US",
            "telephone_number": "763-682-1313",
            "fax_number": "763-581-9090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERWYN",
        "first_name": "JACOB",
        "middle_name": "PATRICK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-08",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jberwyn127058@direct.northmemorial.com",
            "affiliation": "N",
            "address_1": "1700 Highway 25 N",
            "city": "Buffalo",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553131930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jberwyn127058@direct.northmemorial.com",
            "affiliation": "N",
            "address_1": "1001 Hart Blvd Ste 100",
            "city": "Monticello",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553628929",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jberwyn127058@direct.northmemorial.com",
            "affiliation": "N",
            "address_1": "11091 Jason Ave NE Ste 1",
            "city": "Albertville",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553014703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physician Assistant in Monticello, MN
• Providers in Monticello, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.