NPIMap

Individual provider Active NPI

Shelly Lynn Larson, PA-C

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1982690145
Registry record updated May 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9815 Issued in MN
Practice address
4480 Centerville Rd
Saint Paul, MN 55127-3674
Phone
(651) 484-2724
Fax
(651) 484-2723
NPI assigned
Sep 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2012

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 9815 MN Primary

Addresses

Primary practice location

4480 Centerville Rd
Saint Paul, MN 55127-3674

Mailing address

4480 Centerville Rd
Saint Paul, MN 55127-3674
Phone (651) 484-2724

Other names 1

  • Ms. Shelly Lynn Bergh Former name

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
I20040130000573 MN Practitioner - Physician Assistant 9436052057 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008-1920

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9815MNMDDentist
1196MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Feb 15, 2021 Accepting new patients
Allina Health System CurrentSince Feb 15, 2021 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System Past Accepting new patients
Rappahannock Gastroenterology Associates, PLC Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6774/brand/1/csg/1/fhir/r4
  • Direct secure messaging: slarson550845@excellian.direct.allina.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 and National Provider Directory roles.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336953600000",
    "number": "1982690145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "SAINT PAUL",
            "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": "4480 CENTERVILLE RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551273674",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "SHELLY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2012-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "BERGH",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.