Individual provider Active NPI

Timothy Louis Roach, M.D.

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1104203397
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
65564 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-6000
NPI assigned
Apr 27, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 35133683 OH
Internal Medicine Physician 207R00000X 65564 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

4235 Secor Rd
Toledo, OH 43623-4231
Phone (419) 473-5327

Other practice location 1

2213 Franklin Ave
Toledo, OH 43620
Phone (419) 251-4554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190607000046 MN Practitioner - Internal Medicine 3476835448 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

500 S Maple St
Waconia, MN 55387-1752
Phone (952) 442-2191

560 S Maple St
Waconia, MN 55387-1757

7907 Powers Blvd
Chanhassen, MN 55317-9502
Phone (952) 934-0570

Hospital & facility affiliations

  • Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

Merit-based Incentive Payment System (MIPS)

Final score
96.44 of 100Reported as group
Quality
82.65
Promoting interoperability
100
Improvement activities
40
Cost
77.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
65564MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Valley Health Center Inc CurrentSince Dec 31, 2023 Accepting new patients
Fairview Bethesda Hospital CurrentSince May 1, 2020 Accepting new patients
Fairview Clinics CurrentSince May 1, 2020 Accepting new patients
Healtheast Care System CurrentSince May 1, 2020 Accepting new patients
Sibley Medical Center CurrentSince Dec 31, 2023 Accepting new patients
Minnesota Valley Health Center Inc CurrentSince Dec 31, 2023 Accepting new patients
Healtheast Woodwinds Hospital CurrentSince May 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Jun 30, 2019 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince May 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Jun 30, 2019 Accepting new patients
Fairview Clinics CurrentSince May 1, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Ridgeview Medical Center CurrentSince Dec 31, 2023 Accepting new patients
Healtheast Medical Research Institute CurrentSince May 1, 2020 Accepting new patients
Healtheast St. John'S Hospital CurrentSince May 1, 2020 Accepting new patients
Ridgeview Medical Center Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Ridgeview Medical Center Past Accepting new patients

Locations

601 W Chandler St
Arlington, MN 55307
Phone (507) 964-2271

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

621 S 4th St
Le Sueur, MN 56058
Phone (507) 665-3375

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

559 Capitol Blvd
Saint Paul, MN 55103
Phone (651) 232-2000

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: troach484806@fairview.direct-ci.com

Organizations & group practices 20

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 20

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1104203397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 SECOR RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436234231",
            "telephone_number": "419-473-5327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2213 Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "43620",
            "country_code": "US",
            "telephone_number": "419-251-4554",
            "fax_number": "419-251-6795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "TIMOTHY",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-27",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35133683",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "65564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.