Active NPI
Jodi Marie Dessellier, PA-C
- Physician Assistant
- Otsego, MN
National Provider Identifier
1992263917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 12960
- Practice address
- 9245 Quantrelle Ave NE
Otsego, MN 55330-0168 - Phone
- (763) 746-9492
- NPI assigned
- Mar 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 12960 | MN | Primary |
Addresses
Primary practice location
9245 Quantrelle Ave NE
Otsego, MN 55330-0168
Mailing address
1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 628-9566
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190425000632 | MN | Practitioner - Physician Assistant | 7911249842 | Reassigns benefits to 1 organization |
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
- Nystrom and Associates LTD
Practice addresses (Care Compare)
9245 Quantrelle Ave NE
Otsego, MN 55330-0168
Phone (763) 746-9492
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12960 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Support Services Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Counselor
- New Brighton, MN
- NPI 1467549220
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738800000000",
"number": "1992263917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SILVER LAKE RD NW STE 110",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551121789",
"telephone_number": "651-628-9566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9245 QUANTRELLE AVE NE",
"city": "OTSEGO",
"state": "MN",
"postal_code": "553300168",
"telephone_number": "763-746-9492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESSELLIER",
"first_name": "JODI",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-08",
"last_updated": "2025-02-06",
"certification_date": "2025-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "12960",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Otsego, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.