JASON DAVIS (NPI# 1306170808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306170808 |
| Entity Type | Individual |
| Full Name | JASON DAVIS |
| Credential | PA-C |
| Practice Address |
3900 Park Nicollet Blvd St Louis Park MN 55416-2503 |
| Practice Telephone | 9528833150 |
| Mailing Telephone | 9528833150 |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10786 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
10786 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1306170808 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 705 Pleasant Ave S, Park Rapids, MN 564701440 | 2187322800 | 2187322857 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356870927 | Jason Thomas Davis | Counselor | 2530 Crawford Ave Ste 208, Evanston, IL 60201-4959 | 2017-06-07 |
| 1124443486 | Jason Davis | Physical Therapy Assistant | 1840 Hudson Hollow Rd, Stephens City, VA 22655-3330 | 2014-02-24 |
| 1306133392 | Jason O. Davis | Dentist | 4552 Kings Hwy, Brooklyn, NY 11234-2028 | 2011-06-29 |
| 1023322633 | Jason Brandon Davis | Emergency Medical Technician, Basic | 172 Elvington Ln, Lexington, SC 29073-8875 | 2010-08-06 |
| 1285809475 | Jason Evan Davis | Surgery | 150 Bergen Avenue, Uh Division of Vascular Surgery, Newark, NJ 07103 | 2008-04-28 |
| 1467424606 | Jason M Davis | Pediatrics | 183 Cherry St, New Canaan, CT 06840-4820 | 2006-02-02 |
| 1174513832 | Jason Davis | Chiropractor | 16 Highland Spring Rd, Lewiston, ME 04240-3856 | 2005-10-25 |
| 1023632205 | Jason Davis | Physician Assistant | 590 Court St, Keene, NH 03431-1719 | 2020-06-03 |
| 1174029870 | Jason Davis | General Practice | 619 19th St South, Jt N338, Birmingham, AL 35071 | 2018-04-02 |
| 1205352614 | Jason Michael Davis | Physical Therapy Assistant | 13220 Usf Laurel Drive, Tampa, FL 33612 | 2017-08-17 |
| Street Address |
3900 PARK NICOLLET BLVD |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416-2503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447259395 | Ann Kolar Chinnakotla | Nurse Practitioner | 3900 Park Nicollet Blvd, 3rd Floor Urology, St Louis Park, MN 55416-2503 | 2005-07-21 |
| 1073980454 | Teresa Slepicka | Optometrist | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2015-09-01 |
| 1194113217 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2014-12-23 |
| 1164837373 | Erin Marie Sinkoff | Optometrist | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2505 | 2014-06-25 |
| 1477827236 | Christine Kroll | Optometrist | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2012-02-26 |
| 1972837706 | Laura J Heinmiller | Ophthalmology | 3900 Park Nicollet Blvd, Suite 230, St Louis Park, MN 55416-2503 | 2009-09-26 |
| 1134389463 | Hans S Grinager | Ophthalmology | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2008-06-10 |
| 1407974561 | Jonathan Pribila | Ophthalmology | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2007-03-27 |
| 1487668919 | David Warren Pederson | Podiatrist | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2006-07-28 |
| 1851346753 | Paul S Vietzen | Surgery | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2006-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780284844 | Lily Ganz | Physician Assistant | 2737 Huntington Ave, St Louis Park, MN 55416-3917 | 2020-10-28 |
| 1710298336 | Scott Marshall Schmaedeke | Physician Assistant | 1155 Ford Rd Ste B, St Louis Park, MN 55426-1115 | 2010-06-29 |
| 1821075425 | Courtney L Scott | Physician Assistant | 6490 Excelsior Blvd # E500, Park Nicollet Clinic - Meadowbrook, St Louis Park, MN 55426 | 2005-12-27 |
| 1619504768 | Devanie Tucker | Physician Assistant | 3808 Grand Way, St Louis Park, MN 55416-4788 | 2020-03-26 |
| 1083257612 | Kaylie Marie Laplante | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-10-27 |
| 1164994133 | Erik Junso | Physician Assistant | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2019-01-01 |
| 1144790866 | Ashley Marie Overby | Physician Assistant | 5525 Cedar Lake Rd S, St Louis Park, MN 55416-1420 | 2018-11-26 |
| 1043790553 | Jack William Bergman | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-08-15 |
| 1164922910 | Lisa Mary Huset | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-02-19 |
| 1114435773 | Adam James Uithoven | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-01-17 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.