RENAE MACHELLE OTTO PA
NPI 1295696144
Physician Assistant in Coon Rapids, MN

Q: What is Renae Otto's NPI number?

The NPI number for Renae Otto is 1295696144. It was assigned to this individual provider in the NPPES registry on November 20, 2025.

Q: What is Renae Otto's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Renae Otto was last updated on December 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 20, 2025PECOS EnrolledAccepts Medicare Assignment

4040 COON RAPIDS BLVD NW STE 120, COON RAPIDS, MN 55433(763) 427-9980 Get Directions Write a Review

NPPES record last updated: December 14, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 14, 2025, Nov 20, 2025 (2 updates tracked since 2025).

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About Renae Machelle Otto Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RENAE MACHELLE OTTO PA (NPI 1295696144) is an individual physician assistant in Coon Rapids, Minnesota, licensed in Minnesota (15482) and active in the NPI registry since November 2025. She is enrolled in Medicare PECOS, is affiliated with Mercy Hospital, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1295696144

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameRENAE MACHELLE OTTOCredential: PA

Location Address4040 COON RAPIDS BLVD NW STE 120Coon Rapids, MN 55433-4568

Mailing Address4040 Coon Rapids Blvd Nw Ste 120Coon Rapids, MN 55433-4568 · (763) 427-9980

Phone(763) 427-9980

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateNovember 20, 2025

Last NPPES UpdateDecember 14, 20252 updates tracked since enumeration

NPPES CertifiedDecember 14, 2025

✔ NPI 1295696144 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in MN · 15482

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

4040 COON RAPIDS BLVD NW STE 120, Coon Rapids, MN 55433

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Renae Machelle Otto Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7517452295

PECOS Enrollment IDI20251219001761

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Hospital

Acute Care Hospitals · Coon Rapids, MN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number240115

Location4050 Coon Rapids BlvdCoon Rapids, MN 55433 · Anoka County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55433 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$69.74 typical visit price

range $18.32 – $138.04

Typical copayment $17.43 (range $4.58 – $34.51)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ASHLEE ANN TAYLOR PA-C

Physician Assistant