Jeffrey Charles Otis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12288 Issued in MN

Practice address

640 Jackson St
Saint Paul, MN 55101-2502

Phone

(651) 254-4887

NPI assigned

Oct 4, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Regions Hospital Hospital, Saint Paul, MN, CCN 240106
• Hudson Hospital Hospital, Hudson, WI, CCN 521335

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Group Health, Inc.

  dba HealthPartners Medical Group

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment Care Compare group NPD
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD
• Fairview Health Services

  dba Fairview Emergency Medical Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Group Health, Inc.

  dba HealthPartners Midway Residency Dental

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053
  NPD

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

• Regions Hospital

  dba Phamacy - Outpatient Hospital

  • Pharmacy
  • Saint Paul, MN
  • NPI 1013951748

  Hospital

  Care Compare affiliation
• Regions Hospital

  dba HealthPartners Specialty Center Woodbury

  • General Acute Care Hospital
  • Woodbury, MN
  • NPI 1104681105
  Care Compare affiliation
• Regions Hospital

  dba Regions Hospital Rehabilitation

  • Rehabilitation Clinic/Center
  • Saint Paul, MN
  • NPI 1134157092

  Hospital

  Care Compare affiliation
• Regions Hospital

  dba HealthPartners Surgery Center

  • General Acute Care Hospital
  • Saint Paul, MN
  • NPI 1306873872
  Care Compare affiliation
• Regions Hospital

  • General Acute Care Hospital
  • Saint Paul, MN
  • NPI 1629006457
  Care Compare affiliation
• Regions Hospital

  dba HealthPartners Cancer Care at Lakeview Hospital

  • General Acute Care Hospital
  • Stillwater, MN
  • NPI 1679391122
  Care Compare affiliation
• Regions Hospital

  dba HealthPartners Medical Transportation

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1871929976

  Hospital

  Care Compare affiliation
• Regions Hospital

  • General Acute Care Hospital
  • Coon Rapids, MN
  • NPI 1962149419
  Care Compare affiliation
• Hudson Hospital, Inc.

  dba Hudson Hospital & Clinics

  • Critical Access Hospital
  • Hudson, WI
  • NPI 1396849303
  Care Compare affiliation

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1649720533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTIS",
        "first_name": "JEFFREY",
        "middle_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-04",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Ann-Gajda Osuagwu, LPCC
• Javier Osuna Siles Sr.
• Carin Julianne Osvog, LPCC
• Gretchen I Osweiler
• Lydiah Otachi, NURSE PRACTITIONER
• Ronald J Otremba, MD
• Patrick Ottjes
• Rachael L Ottum, DPT
• Ziad Rashid Oumer
• Our Family Pharmacy LLC

• Physician Assistant in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.