NPIMap

Individual provider Active NPI

Travis L Roethler, PA-C

  • Physician Assistant
  • Faribault, MN
National Provider Identifier
1164400057
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9141 Issued in MN
Practice address
300 State Ave
Faribault, MN 55021-6319
Phone
(507) 333-3300
NPI assigned
Jan 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9141 MN Primary

Addresses

Primary practice location

300 State Ave
Faribault, MN 55021-6319

Mailing address

924 1St St NE
Faribault, MN 55021-5441
Phone (507) 333-3300

Other practice location 1

924 1st St NE
Faribault, MN 55021-5441
Phone (507) 333-3300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address troethler87493@ehrdirect.mayoclinicmsg.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051230000516 MN Practitioner - Physician Assistant 0547282782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

200 1St SWST
Rochester, MN 55905-0001

2200 NW 26TH St
Owatonna, MN 55060-5503
Phone (507) 451-1120

2250 NW 26TH St
Owatonna, MN 55060-5503
Phone (507) 451-3850

300 State Ave
Faribault, MN 55021-6319
Phone (507) 333-3300

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (507) 373-2384

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Oct 27, 2017 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Oct 27, 2017 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

300 State Ave
Faribault, MN 55021
Phone (507) 333-3300

2200 NW 26th St
Owatonna, MN 55060
Phone (507) 451-1120

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Organizations & group practices 3

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1164400057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 1ST ST NE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215441",
            "telephone_number": "507-333-3300",
            "fax_number": "507-333-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 STATE AVE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550216319",
            "telephone_number": "507-333-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "924 1st St NE",
            "address_purpose": "LOCATION",
            "city": "Faribault",
            "state": "MN",
            "postal_code": "550215441",
            "country_code": "US",
            "telephone_number": "507-333-3300",
            "fax_number": "507-333-3214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROETHLER",
        "first_name": "TRAVIS",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "troethler87493@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "300 State Ave",
            "city": "Faribault",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550216319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.