Samuel Carl Gisselman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15416 Issued in MN

Practice address

1801 Nicollet Ave
Minneapolis, MN 55403-3791

Phone

(612) 823-2947

NPI assigned

Jul 1, 2025

Last updated

Jul 3, 2025By 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

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, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Universal Medical Services, IncGroup PAC ID 9032283262, shared by 2 NPIs, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751500800000",
    "number": "1972492114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 XERXES AVE S STE 209",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554102328",
            "telephone_number": "612-388-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 NICOLLET AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033791",
            "telephone_number": "612-823-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GISSELMAN",
        "first_name": "SAMUEL",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Magdy Girgis, MD
• Wageed Girgis
• Biruk Girma
• Cari Ann Giroir, BSN
• Kayla Joy Gish, C.N.P.
• Tate Alan Gisslen, MD
• Alessio Giubellino, M.D.
• Charles Christopher Giuliani, DO
• Aaron Giuseffi, DDS
• Funmi O Giwa

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; 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.