ALEXANDRA LYNN LIETHEN
NPI 1508754979
Physician Assistant in Maple Grove, MN

Q: What is Alexandra Liethen's NPI number?

The NPI number for Alexandra Liethen is 1508754979. It was assigned to this individual provider in the NPPES registry on June 25, 2025.

Q: What is Alexandra Liethen'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 Alexandra Liethen was last updated on June 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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 June 25, 2025PECOS EnrolledAccepts Medicare Assignment

9645 GROVE CIR N STE 100, MAPLE GROVE, MN 55369(763) 302-4114 Get Directions Write a Review

NPPES record last updated: June 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Alexandra Lynn Liethen NPPES

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

ALEXANDRA LYNN LIETHEN (NPI 1508754979) is an individual physician assistant in Maple Grove, Minnesota and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1508754979

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameALEXANDRA LYNN LIETHEN

Location Address9645 GROVE CIR N STE 100Maple Grove, MN 55369-2682

Mailing Address11050 Cedar Hills Blvd Apt 323Minnetonka, MN 55305-3057

Phone(763) 302-4114

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateJune 25, 2025

NPPES CertifiedJune 25, 2025

✔ NPI 1508754979 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

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.

9645 GROVE CIR N STE 100, Maple Grove, MN 55369

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Accepted Insurance

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

Alexandra Lynn Liethen 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 ID4082121058

PECOS Enrollment IDI20250725002487

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55369 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 10

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

KAYLA JOYER FNP

Nurse Practitioner (Family)