NPIMap

Individual provider Active NPI

Jordan Traynham, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1588270136
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13979 Issued in MN
Practice address
717 Delaware St SE Ste 508
Minneapolis, MN 55414-2959
Phone
(612) 626-6911
Fax
(612) 625-3481
NPI assigned
Sep 18, 2020
Last updated
Mar 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 22186 WI
Physician Assistant 363A00000X
Physician Assistant 363A00000X 13979 MN Primary

Addresses

Primary practice location

717 Delaware St SE Ste 508
Minneapolis, MN 55414-2959

Mailing address

200 1St St SW
Rochester, MN 55905-0001

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jtraynham1691613@ehrdirect.mayoclinicmsg.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220317002530 MN Practitioner - Physician Assistant 3375938996 Reassigns benefits to 7 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13979MNMDPhysician Assistant
22186WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Lake City CurrentSince Dec 14, 2025 Accepting new patients
Mayo Clinic Health System-Lake City CurrentSince Mar 22, 2022 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Mar 22, 2022 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Mar 22, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Dec 14, 2025 Accepting new patients
Fairview Health Services CurrentSince May 30, 2025 Accepting new patients
Fairview Health Services CurrentSince May 30, 2025 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Dec 14, 2025 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Past Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Past Accepting new patients
Fairview Express Care Past Accepting new patients

Locations

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

32021 County 24 Blvd
Cannon Falls, MN 55009
Phone (507) 263-6000

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

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

501 State St N
Waseca, MN 56093
Phone (507) 835-1210

Interoperability endpoints

  • Direct secure messaging: jtraynham2668761@fairview.direct-ci.com

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1588270136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 DELAWARE ST SE STE 508",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142959",
            "telephone_number": "612-626-6911",
            "fax_number": "612-625-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAYNHAM",
        "first_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-18",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "22186",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtraynham1691613@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559052029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.