MATTHEW RAY BENNETT (NPI# 1376955971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376955971 |
| Entity Type | Individual |
| Full Name | MATTHEW RAY BENNETT |
| Credential | PA-C |
| Practice Address |
560 S Maple St Suite 200 Waconia MN 55387-1733 |
| Mailing Address |
4200 Dahlberg Dr Suite 300 Golden Valley MN 55422-4840 |
| Practice Telephone | 9524422163 |
| Practice Fax Number | 9524425903 |
| Mailing Telephone | 9525125600 |
| Mailing Fax Number | 9525125651 |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2015-01-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2193 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275879363 | Matthew Scott Bennett | Pharmacist | 6850 N. Lombard, Portland, OR 97203 | 2012-12-18 |
| 1144497306 | Matthew Bennett | Counselor | 701 E Santa Clara St Ste 28d, Ventura, CA 93001-5960 | 2008-05-15 |
| 1316149792 | Matthew Scott Bennett | Psychologist | 1701 Burnt Boat Dr Fl 2, Bismarck, ND 58503-0812 | 2007-06-05 |
| 1144205899 | Matthew P Bennett | Anesthesiology | 2804 Dr John Haynes Dr, Pell City, AL 35125-1438 | 2005-12-14 |
| 1497282529 | Matthew Lee Bennett | Physical Therapist | 3915 Golden Valley Rd, Minneapolis, MN 55422-4249 | 2017-05-19 |
| 1578096996 | Matthew Bennett | Chiropractor | 1178 Fremont Ct, Elkhart, IN 46516-9321 | 2017-04-04 |
| 1184173429 | Matthew E Bennett | Physician Assistant | 89 W Copeland Dr Fl 2, Orlando, FL 32806 | 2016-09-28 |
| 1639583271 | Matthew Bennett | Physical Therapist | 6818 Austin Center Blvd Ste 111, Austin, TX 78731-3199 | 2014-06-11 |
| 1043579600 | Matthew Evans Bennett | Surgery | 1100 9th Ave, Seattle, WA 98101-2756 | 2012-05-16 |
| 1083988836 | Matthew Bennett | Pharmacist | 2801 Bickford Ave, Snohomish, WA 98290-1734 | 2012-02-25 |
| Street Address |
560 S MAPLE ST SUITE 200 |
| City | WACONIA |
| State | MN |
| Zip Code | 55387-1733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750379178 | Cheryl A Hansen | Obstetrics & Gynecology | 560 S Maple St, Suite 130, Waconia, MN 55387-1733 | 2005-10-10 |
| 1790339497 | Dana Lee Cox | Occupational Therapist | 560 S Maple St, Waconia, MN 55387-1733 | 2019-07-31 |
| 1548828700 | Lindsay Marie Getten | Specialist/Technologist | 560 S Maple St, Waconia, MN 55387-1733 | 2019-06-03 |
| 1225422819 | Jeffrey Chrest | Specialist/Technologist | 560 S Maple St, Suite 210, Waconia, MN 55387-1733 | 2015-03-23 |
| 1346656089 | Shawn Johnson | Advanced Practice Midwife | 560 S Maple St, Suite 130, Waconia, MN 55387 | 2014-07-02 |
| 1043636145 | Meghan M Kolumbus | Specialist/Technologist | 560 S Maple St, Suite 200, Waconia, MN 55387-1733 | 2014-03-13 |
| 1043566003 | Laurie K. Grotzinger | Physician Assistant | 560 S Maple St, Suite 400, Waconia, MN 55387-1733 | 2012-07-27 |
| 1013277052 | Benjamin James Stasik | Physician Assistant | 560 S Maple St, Suite 200, Waconia, MN 55387-1733 | 2012-05-24 |
| 1922300979 | Jina M Burman | Physical Therapist | 560 S Maple St, Suite 200, Waconia, MN 55387-1733 | 2010-11-24 |
| 1417276304 | Ryan J. Bakko | Physician Assistant | 560 S Maple St, Suite 200, Waconia, MN 55387-1733 | 2010-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023626256 | Katelyn Neufeld | Midwife | Western Obgyn 560 S Maple St, Suite 130, Waconia, MN 55387 | 2020-07-14 |
| 1871074674 | Ashley Bea Johnson | Registered Nurse | 1866 Sandbar Cir, Waconia, MN 55387 | 2018-08-28 |
| 1740642529 | Ryan Christenson | Chiropractor | 32 E Main St., Waconia, MN 55387 | 2016-03-22 |
| 1942638481 | Katie Elizabeth Leuning-pavek | Marriage & Family Therapist | 1657 Interlaken Ct, Waconia, MN 55387 | 2013-10-18 |
| 1083964837 | Auburn Meadows, LLC | Assisted Living Facility | 591 S. Cherry Dr, Waconia, MN 55387 | 2012-09-19 |
| 1114238821 | Jalissa Joy Kruckman | Dentist | 576 Cherry Dr, Waconia, MN 55387 | 2010-06-28 |
| 1194990143 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 121 Depot Dr, Waconia, MN 55387 | 2008-04-29 |
| 1417156662 | Heather Anne Noel Tuttle | Optometrist | 753 Marketplace Drive, Waconia, MN 55387 | 2007-07-17 |
| 1366507436 | Waconia School District | Local Education Agency (LEA) | 512 Industrial Blvd, Waconia, MN 55387 | 2006-12-27 |
| 1295898872 | Haven Chemical Health Systems | Counselor | 233 1st St W, Waconia, MN 55387 | 2006-12-18 |
| Find all providers in zip 55387 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417276304 | Ryan J. Bakko | Physician Assistant | 560 S Maple St, Suite 200, Waconia, MN 55387-1733 | 2010-05-18 |
| 1568575728 | Eugene P Whitbeck | Physician Assistant | 501 S Maple St, Waconia, MN 55387-1715 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194120204 | Nathan C Clapper | Physician Assistant | 3580 Arcade St Ste 100, Vadnais Heights, MN 55127-7135 | 2014-10-31 |
| 1003180555 | Elizabeth K Saterenzoller | Physician Assistant | 1015 Marsh Street, Mankato, MN 56002-8673 | 2012-03-01 |
| 1477824472 | Andrea Jo Pitzl | Physician Assistant | 3208 36th Ave Ne, St Anthony, MN 55418-1713 | 2012-01-23 |
| 1447560693 | Jeanine Marie Edstrom | Physician Assistant | 1185 Town Centre Dr Ste 200, Eagan, MN 55123-1343 | 2010-10-20 |
| 1841504792 | Michelle R Aumock | Physician Assistant | 8100 W 78th Street, Ste 230, Edina, MN 55439 | 2010-08-03 |
| 1194042390 | Gerald Frederick Anderson | Physician Assistant | 4060 Haines Rd, #104, Duluth, MN 55811-1746 | 2010-04-27 |
| 1558683904 | Oswaldo Serge | Physician Assistant | 4036 3rd St Nw, Rochester, MN 55901-7564 | 2010-02-25 |
| 1417288945 | Amanda Kay Johnson | Physician Assistant | 201 W Center St Ei-01 Surgical Assistant, Rochester, MN 55902-3003 | 2010-01-22 |
| 1790922755 | Jenelle Cecilia Rock | Physician Assistant | 1950 Northwestern Ave S, Suite 102, Stillwater, MN 55082-7590 | 2009-01-13 |
| 1174775514 | Nathan J Nistler | Physician Assistant | 3580 Arcade Stq, Vadnais Heights, MN 55127-7135 | 2008-10-16 |
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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.