Individual provider Active NPI

Andrew John Poczos Jr., PA-C

  • Physician Assistant
  • Rochester, MN
National Provider Identifier
1184600488
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9207 Issued in MN
Practice address
1650 4TH St SE
Rochester, MN 55904-4717
Phone
(507) 529-6600
NPI assigned
Dec 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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 9207 MN Primary

Addresses

Primary practice location

1650 4TH St SE
Rochester, MN 55904-4717

Mailing address

1650 4TH St SE
Rochester, MN 55904-4717
Phone (507) 529-6600

Other identifiers 2

IdentifierTypeStateIssuer
080992600MedicaidMN
970003981OtherMNMEDICARE RAILROAD

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100604000769 MN Practitioner - Physician Assistant 5193855922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olmsted Medical CenterGroup PAC ID 8527970060, 324 clinicians

Practice addresses (Care Compare)

1650 4TH St SE
Rochester, MN 55904-4717

Hospital & facility affiliations

  • Olmsted Medical Center Hospital, Rochester, MN, CCN 240006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9207MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Olmsted Medical Center CurrentSince Jun 9, 2014 Accepting new patients

Locations

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1184600488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 4TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044717",
            "telephone_number": "507-529-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 4TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044717",
            "telephone_number": "507-529-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POCZOS",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080992600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "970003981",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.