NPIMap

Individual provider Active NPI

Nathan Reyelts, PA-C

  • Physician Assistant
  • Fairmont, MN
National Provider Identifier
1932183084
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9910 Issued in MN
Practice address
1950 Center Creek Dr
Suite 100
Fairmont, MN 56031-3428
Phone
(507) 238-4968
NPI assigned
Dec 2, 2005
Last updated
Sep 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9910 MN Primary

Addresses

Primary practice location

1950 Center Creek Dr
Suite 100
Fairmont, MN 56031-3428

Mailing address

1950 Center Creek Dr
Suite 100
Fairmont, MN 56031-3428
Phone (507) 238-4968

Other identifiers 10

IdentifierTypeStateIssuer
320K0REOtherMNBLUE CROSS
MH9041041957OtherMNPREFERRED ONE
01-18804OtherMNMEDICA
4686OtherMNAVERA
959478MedicaidIA
HP47426OtherMNHEALTH PARTNERS
320K0REMedicaidMN
131996MedicaidMN
2229453OtherMNARAZ
151650700MedicaidMN

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL dmc Health Information Exchange (HIE)
Direct Messaging Address nathanreyelts@mklt.allscriptsdirect.net 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
I20041020000147 MN Practitioner - Physician Assistant 4587625918 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Clinic, PSCGroup PAC ID 6204288830, 5 clinicians

Practice addresses (Care Compare)

1000 1St Dr NW
Austin, MN 55912-2941
Phone (507) 433-7351

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (507) 373-2384

410 Downtown PLZ
Fairmont, MN 56031-1714
Phone (641) 295-9855

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9910MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Oct 30, 2015 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Oct 30, 2015 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

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

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

Interoperability endpoints

  • Direct secure messaging: cornerstoneclinic.nathanreyelts@157537.advancedmd-direct.com
  • Direct secure messaging: nathanreyelts@mklt.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1932183084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 CENTER CREEK DR",
            "address_2": "SUITE 100",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560313428",
            "telephone_number": "507-238-4968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 CENTER CREEK DR",
            "address_2": "SUITE 100",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560313428",
            "telephone_number": "507-238-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYELTS",
        "first_name": "NATHAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "320K0RE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "MH9041041957",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-18804",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVERA",
            "identifier": "4686",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "959478",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP47426",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320K0RE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131996",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "2229453",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151650700",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dmc",
            "affiliation": "N",
            "endpointDescription": "ecw p2p",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "emr",
            "address_1": "1950 Center Creek Dr",
            "address_2": "Suite 100",
            "city": "Fairmont",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560313428",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nathanreyelts@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1230 E Main St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560015066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairmont, MN

Sources for this page

Verify at the official NPI Registry.