Individual provider Active NPI

Kyle J Tooley, PA-C

  • Physician Assistant
  • Rochester, MN
National Provider Identifier
1649588617
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11617 Issued in MN
Practice address
1650 4TH St SE
Rochester, MN 55904-4717
Phone
(507) 529-6600
NPI assigned
Sep 23, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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 10001220A IN
Physician Assistant 363A00000X 11617 MN Primary

Addresses

Primary practice location

1650 4TH St SE
Rochester, MN 55904-4717

Mailing address

1650 4TH St SE
Rochester, MN 55904-4717
Phone (507) 529-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150505001321 MN Practitioner - Physician Assistant 3072700780
I20190329001447 NY Practitioner - Physician Assistant 3072700780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

210 9TH St SE
Rochester, MN 55904-6425

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
021909NYMDSpeech-Language Pathologist
10001220AINMDPhysician Assistant
11617MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 16, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 16, 2019 Accepting new patients
Ladd Memorial Hospital Past Accepting new patients
Pratt Family Chiropractic LLC PastSince Aug 1, 2012 Accepting new patients
Tri-State Orthopaedic Surgeons, Inc. Physician Assistant Past Accepting new patients

Locations

17 E 102nd St
New York, NY 10029
Phone (212) 241-7968

10 Union Sq E
New York, NY 10003
Phone (212) 253-6800

Interoperability endpoints

  • Direct secure messaging: ktooley17476@direct.olmmed.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1649588617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 4TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044717",
            "telephone_number": "507-529-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 4TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044717",
            "telephone_number": "507-529-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOOLEY",
        "first_name": "KYLE",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-23",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001220A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.