Individual provider Active NPI

Nicole Rae Pelach, N.P.

  • Family Nurse Practitioner
  • Owatonna, MN
National Provider Identifier
1336499904
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1207 Issued in MN
Practice address
2200 NW 26TH St
Owatonna, MN 55060-5503
Phone
(507) 451-1120
NPI assigned
Sep 11, 2012
Last updated
Feb 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R 130266-8 MN
Family Nurse Practitioner 363LF0000X 1207 MN Primary

Addresses

Primary practice location

2200 NW 26TH St
Owatonna, MN 55060-5503

Mailing address

720 Washington Ave SE Ste 300
Minneapolis, MN 55414-2904
Phone (612) 672-7422

Other practice location 1

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Other names 1

  • Nicole Rae Tabatt Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address npelach272627@ehrdirect.mayoclinicmsg.org

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
I20121024000286 MN Practitioner - Nurse Practitioner 9830349000 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

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

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

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
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1207MNMDRegistered Dietitian
R 130266-8MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Aug 12, 2019 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Nov 1, 2021 Accepting new patients
Fairview Express Care CurrentSince Aug 12, 2019 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Nov 1, 2021 Accepting new patients
Cardiothoracic Surgery Clinic of North Ms Past Accepting new patients

Locations

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

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

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

Interoperability endpoints

  • Direct secure messaging: npelach272627@ehrdirect.mayoclinicmsg.org

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1336499904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WASHINGTON AVE SE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142904",
            "telephone_number": "612-672-7422",
            "fax_number": "612-884-0907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NW 26TH ST",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550605503",
            "telephone_number": "507-451-1120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "909 Fulton St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554554800",
            "country_code": "US",
            "telephone_number": "612-672-7422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELACH",
        "first_name": "NICOLE",
        "middle_name": "RAE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 130266-8",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "1207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "npelach272627@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "2200 NW 26th St",
            "city": "Owatonna",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550605503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "TABATT",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Owatonna, MN

Sources for this page

Verify at the official NPI Registry.