MRS. KATHERINE ROSE CLARK PA-C
NPI 1003683509
Physician Assistant in Crystal, MN

Q: What is Katherine Clark's NPI number?

The NPI number for Katherine Clark is 1003683509. It was assigned to this individual provider in the NPPES registry on December 5, 2023. The provider is also known as Ms. Katherine Rose Mattinen Pa-C.

Q: What is Katherine Clark's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Katherine Clark was last updated on March 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 05, 2023PECOS EnrolledAccepts Medicare Assignment

5109 36TH AVE N, CRYSTAL, MN 55422(763) 587-7999(763) 587-7989 Get Directions Write a Review

NPPES record last updated: March 31, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 31, 2025, Mar 26, 2025, Dec 5, 2023 (3 updates tracked since 2023).

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About Mrs. Katherine Rose Clark Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KATHERINE ROSE CLARK PA-C (NPI 1003683509) is an individual physician assistant in Crystal, Minnesota, licensed in Minnesota (14744) and active in the NPI registry since December 2023. She is enrolled in Medicare PECOS, is affiliated with North Memorial Health Hospital, and maintains a secondary practice location in Maple Grove.

NPPES Registry Identity

NPI1003683509

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMRS. KATHERINE ROSE CLARKCredential: PA-C

Location Address5109 36TH AVE NCrystal, MN 55422

Mailing Address5109 36th Ave NCrystal, MN 55422 · (763) 587-7999 · Fax (763) 587-7989

Phone(763) 587-7999

Fax(763) 587-7989

Sole ProprietorNo

Medical School CMSTouro Un Col Of Osteopathic Medicine, HendersonGraduated 2023

Enumeration DateDecember 5, 2023

Last NPPES UpdateMarch 31, 20253 updates tracked since enumeration

NPPES CertifiedMarch 26, 2025

✔ NPI 1003683509 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in MN · 14744

Definition

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.

5109 36TH AVE N, Crystal, MN 55422

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Other Names 1

Former Name (1)Ms. Katherine Rose Mattinen Pa-c

Secondary Practice Location 1

Location 19825 Hospital Dr Ste 300Maple Grove, MN 55369-4768 · Phone (763) 587-7999

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Katherine Rose Clark Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1759732951

PECOS Enrollment IDI20240112000539

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

73 services69 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

18 services16 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

North Memorial Health Hospital

Acute Care Hospitals · Robbinsdale, MN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number240001

Location3300 Oakdale NorthRobbinsdale, MN 55422 · Hennepin County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55422 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$69.74 typical visit price

range $18.32 – $138.04

Typical copayment $17.43 (range $4.58 – $34.51)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CAITLIN RUTH KUCK MD

Obstetrics & Gynecology