NPIMap

Individual provider Active NPI

Jake Michael Traxler, MD

  • Family Medicine Physician
  • Glencoe, MN
National Provider Identifier
1780171413
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
65946 Issued in MN
Practice address
1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone
(320) 864-3121
NPI assigned
Apr 18, 2018
Last updated
Apr 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 65946 MN Primary

Addresses

Primary practice location

1805 Hennepin Ave N
Glencoe, MN 55336-1416

Mailing address

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-3121

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jtraxler562935@excellian.direct.allina.com Direct

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
I20210922000029 MN Practitioner - Family Practice 5597199448 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glencoe Regional Health ServicesGroup PAC ID 1759292980, 45 clinicians

Practice addresses (Care Compare)

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-3121

1805 N Hennepin Ave
Glencoe, MN 55336-1416

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65946MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Glencoe Regional Health Services CurrentSince Sep 7, 2021 Accepting new patients
Glencoe Regional Health Services CurrentSince Sep 7, 2021 Accepting new patients
Glencoe Regional Health Services Past Accepting new patients

Locations

1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121

300 Bowman St
Stewart, MN 55385
Phone (320) 562-2558

Interoperability endpoints

  • Direct secure messaging: jtraxler562935@excellian.direct.allina.com

Organizations & group practices 3

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 8

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": "1524009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1780171413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAXLER",
        "first_name": "JAKE",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-18",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "65946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtraxler562935@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1805 Hennepin Ave N",
            "city": "Glencoe",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553361416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Glencoe, MN

Sources for this page

Verify at the official NPI Registry.