Individual provider Active NPI

Micah Jon Nieboer, MD

  • Orthopaedic Surgery Physician
  • Rochester, MN
National Provider Identifier
1336702224
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
68395 Issued in MN
Practice address
200 1St St SW
Rochester, MN 55905-2305
Phone
(507) 284-2511
NPI assigned
Apr 17, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 68395 MN Primary
Orthopaedic Surgery Physician 207X00000X 30229 MN
Orthopaedic Surgery Physician 207X00000X ME168209 FL

Addresses

Primary practice location

200 1St St SW
Rochester, MN 55905-2305

Mailing address

PO Box 860912
Minneapolis, MN 55486-0912
Phone (507) 284-2511

Other practice location 1

5901 E Fowler Ave Ste 100
Temple Terrace, FL 33617-2305
Phone (813) 978-9700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mnieboer431698@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201124001208 MN Practitioner - Orthopedic Surgery 0547595803 Reassigns benefits to 1 organization
I20240715004349 FL Practitioner - Orthopedic Surgery 0547595803 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Loyola University of Chicago, Stritch School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo ClinicGroup PAC ID 6507778255, 4,829 clinicians

Practice addresses (Care Compare)

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME168209FLMDOrthopaedic Surgery Physician
30229MNMDOrthopaedic Surgery Physician
68395MNMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Sep 11, 2024 Accepting new patients
Mayo Clinic Orthopaedic Surgery CurrentSince Nov 2, 2020 Accepting new patients
Musculoskeletal Institute Chartered Orthopaedic Surgery CurrentSince Jul 25, 2024 Accepting new patients
Mayo Clinic CurrentSince Nov 2, 2020 Accepting new patients
Tallahassee Orthopedic Clinic III PL Orthopaedic Surgery CurrentSince Sep 11, 2024 Accepting new patients
Tampa General Hospital Current Accepting new patients
Musculoskeletal Institute Chartered Orthopaedic Surgery CurrentSince Jul 25, 2024 Accepting new patients
Musculoskeletal Institute Chartered Orthopaedic Surgery Current Accepting new patients

Locations

3334 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 210-1808

909 N Dale Mabry Hwy
Fl Orthopaedic
Tampa, FL 33609

909 N Dale Mabry Hwy
Tampa, FL 33609
Phone (813) 287-9370

13060 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

13020 N Telecom Pkwy
Temple Terrace, FL 33637

5901 E Fowler Ave
Ste 100
Temple Terrace, FL 33617
Phone (813) 987-9700

13020 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

2044 Trinity Oaks Blvd
Ste 110
Trinity, FL 34655
Phone (813) 978-7000

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: mnieboer431698@ehrdirect.mayoclinicmsg.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mnieboer257846@direct.tgh.org

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1336702224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860912",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860912",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559052305",
            "telephone_number": "507-284-2511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901 E Fowler Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Temple Terrace",
            "state": "FL",
            "postal_code": "336172305",
            "country_code": "US",
            "telephone_number": "813-978-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIEBOER",
        "first_name": "MICAH",
        "middle_name": "JON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-17",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "68395",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "30229",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME168209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mnieboer431698@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559052305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.