Mark L Roa, MA, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3689 Issued in MN

Practice address

2545 Chicago Ave
Suite 701
Minneapolis, MN 55404-4522

Phone

(612) 863-5327

Fax

(612) 863-2596

NPI assigned

Apr 12, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mroa86757@excellian.direct.allina.com

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

• Allina Health System

  dba Allina Health Buffalo Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  NPD
• Allina Health System

  dba Allina Health Non-Hospice Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Minneapolis, MN
  • NPI 1598230138
  NPD
• Allina Health System

  dba Allina Health TeleRheumatology

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1275597957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MR 10809",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-4813",
            "fax_number": "612-262-4194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 CHICAGO AVE",
            "address_2": "SUITE 701",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044522",
            "telephone_number": "612-863-5327",
            "fax_number": "612-863-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROA",
        "first_name": "MARK",
        "middle_name": "L",
        "credential": "MA, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riyo Home Care LLC
• George Rizkalla
• Rebecca Corinne Rizzuto, ADVANCED MASSAGE PRA
• Rlunderhill Psychotherapy and Healing LLC (Dba Dragon Fire Healing Collective)
• Ro Chiropractic PLLC
• Eric A. Roach, MD
• Timothy Louis Roach, M.D.
• Road2Recovery LLC
• Parrisha Laurence Roane, MD
• Daniel Bernard Robb, RN

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.