DR. MARISA LYNN PENDER DNP, FNP-C
NPI 1710454517
Nurse Practitioner - Family in Eden Prairie, MN
About Dr. Marisa Lynn Pender Dnp, Fnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MARISA LYNN PENDER DNP, FNP-C (NPI 1710454517) is an individual family provider in Eden Prairie, Minnesota, licensed in Minnesota (10596) and active in the NPI registry since October 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Marisa Lynn Pender Dnp, Fnp-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.
Medicare Billing Reassignment
Medicare enrollment records show Marisa Pender reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Eden Prairie, MN 55344
- Reassigned Medicare billing, Minnesota enrollment
- 30 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55344 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 19
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
EDEN PRAIRIE, MN 55344
EDEN PRAIRIE, MN 55344
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Marisa Pender's NPI number?
The NPI number for Marisa Pender is 1710454517. It was assigned to this individual provider in the NPPES registry on October 30, 2018. The provider is also known as Marisa Lynn Shady Bsn, Rn.
Where is Marisa Pender located?
Marisa Pender practices at 6452 City West Pkwy, Eden Prairie, MN 55344. The listed phone number is (952) 999-0333.
What is Marisa Pender's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Marisa Pender enrolled in Medicare?
Yes. Marisa Pender is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Marisa Pender's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Marisa Pender reassigns Medicare benefits to New Kingdom Pediatrics LLC (Eden Prairie, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Marisa Pender's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Marisa Pender was last updated on August 11, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# Dr. Marisa Lynn Pender, DNP, FNP-C · NPI 1710454517
Family physician in Eden Prairie, Minnesota. Individual provider, active in the CMS NPPES registry since October 30, 2018.
## Identity
- **NPI:** 1710454517 (Entity type: Individual)
- **Enumerated:** October 30, 2018
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 10596 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 6452 CITY WEST PKWY, Eden Prairie, MN 55344-3245
- **Phone:** (952) 999-0333
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** New Kingdom Pediatrics LLC (NPI 1760816045, Eden Prairie, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** August 11, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1710454517) · Data from the CMS NPPES public registry.