Rose Rogstad Rooney, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9700 Issued in MN

Practice address

6485 City West Pkwy
Eden Prairie, MN 55344-3246

Phone

(952) 933-1150

NPI assigned

Jun 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Rose Rogstad Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Sports & Family Wellness, PLLC

  • Medical Specialty Clinic/Center
  • Hopkins, MN
  • NPI 1982030706
  NPD

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1285839050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 101ST ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554205122",
            "telephone_number": "425-501-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6485 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443246",
            "telephone_number": "952-933-1150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 E Kincaid St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982744127",
            "country_code": "US",
            "telephone_number": "360-428-6482",
            "fax_number": "360-428-6485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROONEY",
        "first_name": "ROSE",
        "middle_name": "ROGSTAD",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10003688",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSE",
            "last_name": "ROGSTAD",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taylor Rolstad
• Lauren Elizabeth Romaniello
• Mario Romano, OD
• Claire Rondeau
• Taylor Rookstool, APRN
• Ros Home Health Care, Inc.
• Ros Medical Supply Inc
• Rosario Grau MD PA
• Kimberly Roseman, LADC
• Claire Rosen, MA, LPCC, LADC

• Physician Assistant in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.