NPIMap

Individual provider Active NPI

Jenelle Cecilia Rock, PA-C

  • Physician Assistant
  • Stillwater, MN
National Provider Identifier
1790922755
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12053 Issued in MN
Practice address
1950 Northwestern Ave S
Suite 102
Stillwater, MN 55082-7590
Phone
(651) 430-3800
Fax
(651) 430-3827
NPI assigned
Jan 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

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 12053 MN Primary
Surgical Physician Assistant 363AS0400X

Addresses

Primary practice location

1950 Northwestern Ave S
Suite 102
Stillwater, MN 55082-7590

Mailing address

1950 Northwestern Ave S
Ste 102
Stillwater, MN 55082-7615
Phone (651) 430-3800

Other identifiers 1

IdentifierTypeStateIssuer
47061995513MedicaidNE

Other names 1

  • Jenelle Cecilia Green Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jrock320322@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
I20160203002325 MN Practitioner - Physician Assistant 6002973112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

11850 Blackfoot St NW
Coon Rapids, MN 55433-2773

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6000

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

800 E 28TH St
Minneapolis, MN 55407-3723

913 E 26TH St
Minneapolis, MN 55404-4515

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2394MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Oct 1, 2016 Accepting new patients
Allina Health System CurrentSince Oct 1, 2016 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

800 E 28th St
#305
Minneapolis, MN 55407
Phone (612) 871-7278

913 E 26th St
Ste 305
Minneapolis, MN 55404
Phone (612) 871-7278

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

Organizations & group practices 5

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.

Hospital & facility affiliations 47

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

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1790922755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 NORTHWESTERN AVE S",
            "address_2": "STE 102",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827615",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 NORTHWESTERN AVE S",
            "address_2": "SUITE 102",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827590",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROCK",
        "first_name": "JENELLE",
        "middle_name": "CECILIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-13",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12053",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47061995513",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jrock320322@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "913 E 26th St Ste 305",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554044515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENELLE",
            "last_name": "GREEN",
            "middle_name": "CECILIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.