Active NPI
Samantha Roth, PA
- Physician Assistant
- Cottage Grove, MN
National Provider Identifier
1295543262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 15237
- Practice address
- 8611 W Point Douglas Rd S
Cottage Grove, MN 55016-4005 - Phone
- (651) 458-1884
- NPI assigned
- Dec 23, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 15237 | MN | Primary |
Addresses
Primary practice location
8611 W Point Douglas Rd S
Cottage Grove, MN 55016-4005
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sanderson642428@excellian.direct.allina.com | Direct |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225
8611 W Point Douglas Rd S
Cottage Grove, MN 55016-4005
Phone (651) 458-1884
Hospital & facility affiliations
- Allina United Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15237 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Past | Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
8611 W Point Douglas Rd S
Cottage Grove, MN 55016
Phone (651) 458-1884
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
Interoperability endpoints
- sanderson642428@excellian.direct.allina.com
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Annandale, MN
- NPI 1457657249
-
- Sleep Medicine (Internal Medicine) Physician
- Edina, MN
- NPI 1831951441
-
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
-
- Family Medicine Physician
- Minneapolis, MN
- NPI 1467758813
Hospital & facility affiliations 15
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- St Paul, MN
- NPI 1265474704
Hospital
-
- General Acute Care Hospital
- Saint Paul, MN
- NPI 1457319485
-
- General Acute Care Hospital
- Hastings, MN
- NPI 1508457045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772668800000",
"number": "1295543262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8611 W POINT DOUGLAS RD S",
"city": "COTTAGE GROVE",
"state": "MN",
"postal_code": "550164005",
"telephone_number": "651-458-1884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "SAMANTHA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-23",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "15237",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sanderson642428@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "8611 W Point Douglas Rd S",
"city": "Cottage Grove",
"state": "MN",
"country_code": "US",
"postal_code": "550164005",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Cottage Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.