Active NPI 1770639635 Individual Practitioner Female Practitioner

Annetta M Shaw , RN, BSN, CRNFA

Physician Assistant - Surgical • Bemidji, MN

Professional Overview & Biography Verified Profile Summary

Annetta Shaw, RN, BSN, CRNFA is a registered healthcare professional specializing in Physician Assistant - Surgical in Bemidji, MN. Practice services are available at 3807 GREENLEAF AVE NW under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

3807 Greenleaf Ave Nw

Bemidji, MN 566015817

Telephone 2187519746

Fax 2187590620

Associated Practice Facility / Clinic

🏢 Lake Region Bone & Joint Surgeons Facility NPI 1790781235

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant - Surgical in Bemidji, MN

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 15.0 Yrs

State Avg: 13.3 Yrs

Regional Practice Density

4 Specialists

Practicing in Bemidji, MN (229 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant - Surgical Primary Specialty

NUCC Taxonomy Code: 363AS0400X

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Blue Cross Blue Shield

85G67SH (MN)

Commercial Insurance / Payer ID Prefferedone

855911029535 (MN)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

16 Associated Practitioners

Dr. Jason Caron , MD

Orthopaedic Surgery

NPI 1114070182

Doctor of Medicine (M.D.)

Alexandria Sand , MS, LAT, ATC

Specialist/Technologist - Athletic Trainer

NPI 1154739456

Master of Science, Licensed Athletic Trainer, Certified Athletic Trainer

Dr. Terrance Johnson , MD

Orthopaedic Surgery

NPI 1194721290

Doctor of Medicine (M.D.)

Linda Helgeson , NP

Nurse Practitioner

NPI 1194910505

Nurse Practitioner

Dr. Kyle Templin , DPM

Podiatrist - Foot & Ankle Surgery

NPI 1205198157

Doctor of Podiatric Medicine

Katherine Smith , PA-C

Physician Assistant

NPI 1205328549

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 3807 GREENLEAF AVE NW, BEMIDJI, MN 566015817 (Tel: 2187519746)

📍

Updated Business Mailing Address July 08, 2007

Registered at 3807 GREENLEAF AVE NW, BEMIDJI, MN 566015817 (Tel: 2187519746)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as ANNETTA SHAW, RN,BSN,CRNFA

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Physician Assistant

🟢

Initial NPI Registration & Enumeration January 25, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1770639635

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: January 25, 2007

Last Update: July 08, 2007

Sole Proprietor: No

Update or Correct Profile

Mailing Address

3807 Greenleaf Ave Nw

Bemidji, MN 566015817

Phone: 2187519746

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.