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Deactivated NPI 1861747131 Deactivated / Inactive NPI Female Practitioner

Doline Monyenye Omirera Kebasso , PA-C

Physician Assistant • Robbinsdale, MN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Doline Omirera Kebasso has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 23, 2012
NPI Deactivation Date August 24, 2021
Total Practice Duration ~9 Years of Practice (2012 – 2021)

Professional Overview & Biography Verified Profile Summary

Doline Omirera Kebasso, PA-C was a registered Physician Assistant practicing in Robbinsdale, MN. Throughout an active medical career spanning 9 years, Doline Omirera Kebasso provided care at the practice location at 3366 OAKDALE AVE N until profile deactivation on 2021-08-24.

Practice Location & Contact Primary Location

Practice Address

3366 Oakdale Ave N
Suite 103

Robbinsdale, MN 554222948

Telephone 7635207870
Fax 7635207580
Associated Practice Facility / Clinic
🏢 Hass Enterprises, Inc. Facility NPI 1174534689

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Robbinsdale, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 12.4 Yrs
State Avg: 10.9 Yrs
Regional Practice Density
45 Specialists

Practicing in Robbinsdale, MN (4026 Statewide)

Telehealth Adoption Rate
8.9% 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 Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License MN 1883

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.

Practice Associates & Co-Workers

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

40 Associated Practitioners
Emily Johnson , PA-C

Physician Assistant

NPI 1013309715

Physician Assistant (Certified)

Lisa Hromadka , PA-C

Physician Assistant

NPI 1013962455

Physician Assistant (Certified)

Margaret Baranowski , PA-C

Physician Assistant

NPI 1033130463

Physician Assistant (Certified)

Dr. James Bircher , DO

Orthopaedic Surgery

NPI 1053771204

Doctor of Osteopathic Medicine (D.O.)

Dr. Julie Wenda , DPT

Physical Therapist

NPI 1114215977

Doctor of Physical Therapy

Jarred Frisk , PT

Physical Therapist

NPI 1114618287

Physical Therapist

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated August 24, 2021

Record deactivated on August 24, 2021

NPI Profile Active April 03, 2013

NPI status registered as active in NPPES database

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Updated Practice Location April 03, 2013

Registered at 3366 OAKDALE AVE N, SUITE 103, ROBBINSDALE, MN 554222948 (Tel: 7635207870)

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Updated Business Mailing Address April 03, 2013

Registered at 4200 DAHLBERG DR, SUITE 300, GOLDEN VALLEY, MN 554224840 (Tel: 9525125600)

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Provider Name / Credentials Updated April 03, 2013

Recorded as DOLINE OMIRERA KEBASSO, PA-C

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 03, 2013

Physician Assistant (License #1883 in MN)

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Initial NPI Registration & Enumeration July 23, 2012

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: 1861747131
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 23, 2012
Last Update: April 03, 2013
Deactivation Date: August 24, 2021

Mailing Address

4200 Dahlberg Dr, Suite 300

Golden Valley, MN 554224840

Phone: 9525125600

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.