Carly Witherell, PA-C - Medicare Physician Assistant in Minneapolis, MN

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Carly Witherell, PA-C is a medicare enrolled "Physician Assistant" in Minneapolis, Minnesota. Her current practice location is 420 Delaware St Se, Minneapolis, Minnesota. You can reach out to her office (for appointments etc.) via phone at (612) 884-0600.

Carly Witherell is licensed to practice in Minnesota (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1750904819.

Contact Information

Carly Witherell, PA-C
420 Delaware St Se,
Minneapolis, MN 55455-0341
(612) 884-0600
Not Available

Map and Direction




Provider's Profile

Full NameCarly Witherell
GenderFemale
SpecialityPhysician Assistant
Location420 Delaware St Se, Minneapolis, Minnesota
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1750904819
  • Provider Enumeration Date: 05/24/2020
  • Last Update Date: 08/08/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 2264895192
  • Enrollment ID: I20230825000601

Medical Identifiers

Medical identifiers for Carly Witherell such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1750904819NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant (Minnesota)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carly Witherell allows following entities to bill medicare on her behalf.
Entity NameUniversity of Minnesota Physicians
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1477598118
PECOS PAC ID: 9830001189
Enrollment ID: O20031104000532
Entity NameFairview Health Services
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1811077175
PECOS PAC ID: 1951213057
Enrollment ID: O20031105000461
Entity NameFairview Clinics
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1346432218
PECOS PAC ID: 7113830142
Enrollment ID: O20031106000516
Entity NameHealtheast Medical Research Institute
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1639125503
PECOS PAC ID: 3971407636
Enrollment ID: O20031124000507
Entity NameFairview Express Care
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1053952606
PECOS PAC ID: 3375645179
Enrollment ID: O20081028000548
Entity NameUniversity of Minnesota Health Clinics and Surgery Center Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1053795187
PECOS PAC ID: 9133423304
Enrollment ID: O20160209000524

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carly Witherell is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Carly Witherell, PA-C
420 Delaware St Se,
Minneapolis, MN 55455-0341

Ph: (612) 624-8199		Carly Witherell, PA-C
420 Delaware St Se,
Minneapolis, MN 55455-0341

Ph: (612) 884-0600

Reviews and Comments


Physician Assistant Nurses in Minneapolis, MN

Melissa Richardson, PA-C
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 420 Delaware St Se, Minneapolis, MN 55455
Phone: 612-273-3000    
Ms. Chelsea Anjelica Mielke, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 2450 Riverside Ave, Minneapolis, MN 55454
Phone: 612-672-6000    
Jacqueline Marie Gasperlin, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 800 E 28th St, Minneapolis, MN 55407
Phone: 612-863-4000    
Julianne K Heil, PAC
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 2800 Chicago Ave Ste 300, Minneapolis, MN 55407
Phone: 651-225-7855    Fax: 651-312-1570
Courtney Fields,
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 2211 Riverside Ave, Campus Box 149, Minneapolis, MN 55454
Phone: 612-330-1388    
Tara Jean Rick, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: University Of Minnesota Physicians, 420 Delaware St Se, Mmc276, Minneapolis, MN 55455
Phone: 612-624-0909    
Christine Ray Hsu, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 900 Nicollet Mall, Minneapolis, MN 55403
Phone: 612-338-0035    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.