JENNA AUDREY ROTTY (PA-C) – Physician Assistant, NPI 1497169031
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,032 PHYSICIAN ASSISTANT in MN
Provider Addresses for JENNA AUDREY ROTTY (PA-C)
8600 NICOLLET AVE S
BLOOMINGTON, MN 554202824
Phone: (952) 541-2800
Type: Location
640 JACKSON STREET
MAIL STOP 11503L
ST. PAUL, MN 55101
Phone: (651) 254-3739
Fax: (651) 254-1519
Type: Mailing
640 JACKSON ST
SAINT PAUL, MN 551012502
Phone: (651) 254-3739
Fax: (651) 254-1519
Type: Location
8170 33RD AVE S
MS 21110Q
BLOOMINGTON, MN 554254516
Phone:
Type: Mailing
8170 33RD AVE S # MS 21110Q
MINNEAPOLIS, MN 554254516
Phone:
Type: Mailing
2635 UNIVERSITY AVE W STE 160
SAINT PAUL, MN 551141271
Phone: (952) 967-7960
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-08-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140812001849 | I | Physician Assistant | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55420)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Clinical Psychologist | MN | |
| - | MN | |
| P S Y C H I A T R Y | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| P O D I A T R Y | MN | |
| Physician Assistant | MN | |
| Physician Assistant | MN |
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