Individual provider Active NPI

Rebecca Tighe, PA-C

  • Physician Assistant
  • Lake City, MN
National Provider Identifier
1548855208
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14156 Issued in MN
Practice address
507 W Doughty St
Lake City, MN 55041-1500
Phone
(651) 345-2350
NPI assigned
Mar 4, 2021
Last updated
Nov 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14156 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

507 W Doughty St
Lake City, MN 55041-1500

Mailing address

507 W Doughty St
Lake City, MN 55041-1500
Phone (651) 345-2350

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
I20220917000458 MN Practitioner - Physician Assistant 7416332085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olmsted Medical CenterGroup PAC ID 8527970060, 324 clinicians

Practice addresses (Care Compare)

102 Elton Hills Dr NW
Suite 200
Rochester, MN 55901-3564
Phone (507) 292-7009

132 17TH Ave NW
Suite 132
Rochester, MN 55901-0321
Phone (507) 292-7411

1650 4TH St SE
Rochester, MN 55904-4717

507 W Doughty St
Lake City, MN 55041-1500
Phone (651) 345-2350

90 14TH St SW
Suite 200
Rochester, MN 55902-3822
Phone (507) 292-7009

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Olmsted Medical Center CurrentSince Oct 17, 2022 Accepting new patients

Locations

507 W Doughty St
Lake City, MN 55041
Phone (651) 345-2350

1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

Interoperability endpoints

  • Direct secure messaging: rgoertzen20240@direct.olmmed.org

Organizations & group practices 1

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 2

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": "1614816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1548855208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 W DOUGHTY ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411500",
            "telephone_number": "651-345-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 W DOUGHTY ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411500",
            "telephone_number": "651-345-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIGHE",
        "first_name": "REBECCA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-04",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14156",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, MN

Sources for this page

Verify at the official NPI Registry.