Individual provider Active NPI

Megan Elizabeth Haselbauer, PA-C

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1992051304
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1786 Issued in MN
Practice address
200 University Ave E
Saint Paul, MN 55101-2507
Phone
(651) 578-5238
NPI assigned
Aug 3, 2012
Last updated
Dec 12, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 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 1786 MN Primary

Addresses

Primary practice location

200 University Ave E
Saint Paul, MN 55101-2507

Mailing address

13980 Everest Ave
Apple Valley, MN 55124-6458
Phone (612) 991-3455

Other names 1

  • Megan Elizabeth Tamble Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130301000318 MN Practitioner - Physician Assistant 4082869748 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Nov 18, 2013 Accepting new patients
Fairview Clinics CurrentSince Nov 18, 2013 Accepting new patients
Fairview Clinics CurrentSince Nov 18, 2013 Accepting new patients
Fairview Health Services CurrentSince Nov 18, 2013 Accepting new patients
Gillette Children's Specialty Healthcare CurrentSince Jan 21, 2013 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

305 E Nicollet Blvd
Ste 200
Burnsville, MN 55337
Phone (952) 223-3400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

800 Freeport Ave NW
Ste 100
Elk River, MN 55330
Phone (763) 581-5200

8290 University Ave NE
Ste 200
Fridley, MN 55432
Phone (763) 786-9543

8301 Golden Valley Rd
Ste 100
Minneapolis, MN 55427
Phone (763) 520-2200

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

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1992051304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13980 EVEREST AVE",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551246458",
            "telephone_number": "612-991-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-578-5238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASELBAUER",
        "first_name": "MEGAN",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-03",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEGAN",
            "last_name": "TAMBLE",
            "middle_name": "ELIZABETH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.