JENNIFER S ANDREWS-GONZAGA, PA — NPI 1629031182 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1629031182

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363A00000X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant

Box 32 Service Location & ZIP+4

640 JACKSON ST, MC 11102F, ST PAUL, MN, 55101-2502

✓ 9-Digit EDI 837 ZIP+4 (55101-2502)

Practice Phone & Referral Fax

(651) 254-3456

Fax: (651) 254-5216

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629031182 (JENNIFER S ANDREWS-GONZAGA, PA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1629031182` (NPI-1 Individual Practitioner)
Provider / Legal Name	JENNIFER S ANDREWS-GONZAGA, PA
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant NUCC Code: `363A00000X` (Physician Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	640 JACKSON ST, MC 11102F, ST PAUL, MN, 55101-2502
Practice Telephone / Fax	Tel: (651) 254-3456 \| Fax: (651) 254-5216
Administrative Mailing Address	8100 34TH AVE S, BLOOMINGTON, MN, 55425-1672
Enumeration & Last Sync	Enumerated: 2006-04-07 \| CMS Record Updated: 2018-10-05

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

640 JACKSON ST, MC 11102F, ST PAUL, MN, 55101-2502

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Plain-English Taxonomy & CMS Crosswalk (363A00000X)

What Does Taxonomy Code 363A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JENNIFER S ANDREWS-GONZAGA, PA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: WI \| License: `1840-23` \| Primary: Secondary
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: MN \| License: `9687` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JENNIFER S ANDREWS-GONZAGA, PA (NPI #1629031182)