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DR. MARK ALLEN ROETTGER DDS
NPI 1356325906
Dentist in Lake Elmo, MN

Active since December 06, 2005PECOS Enrolled
12425 55TH STREET N, SUITE B, LAKE ELMO, MN 55042(651) 439-0322(651) 439-2201 Get Directions Write a Review

NPPES record last updated: May 11, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Dr. Mark Allen Roettger Dds NPPES

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

DR. MARK ALLEN ROETTGER DDS (NPI 1356325906) is an individual dentist in Lake Elmo, Minnesota, licensed in Minnesota (9426) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS, is affiliated with M Health Fairview University Of Mn, and is a graduate of University Of Minnesota School Of Dentistry (1982).

NPPES Registry Identity

NPI1356325906
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. MARK ALLEN ROETTGERCredential: DDS
Location Address12425 55TH STREET N, SUITE BLake Elmo, MN 55042-4450
Mailing Address12425 55th Street N, Suite BLake Elmo, MN 55042-4450 · (651) 439-0322 · Fax (651) 439-2201
Phone(651) 439-0322
Fax(651) 439-2201
Sole ProprietorNo
Medical School CMSUniversity Of Minnesota School Of DentistryGraduated 1982
Enumeration DateDecember 6, 2005
Last NPPES UpdateMay 11, 2011
✔ NPI 1356325906 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MN · 9426
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
12425 55TH STREET N, Lake Elmo, MN 55042
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Mark Allen Roettger Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1153506472
PECOS Enrollment IDI20260427001027
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.

Medicare Billing Reassignment

Medicare enrollment records show Mark Roettger reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

University Of Minnesota Physicians
19 mi
Multi-Specialty
720 WASHINGTON AVE SE STE 200
Minneapolis, MN 55414
  • Reassigned Medicare billing, Minnesota enrollment
  • 1,453 clinicians in this Medicare group
NPI 1477598118 (612) 672-7422

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

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

M Health Fairview University Of Mn

Acute Care Hospitals · Minneapolis, MN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240080
Location2450 Riverside AvenueMinneapolis, MN 55454 · Hennepin County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55042 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.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Roettger's NPI number?

The NPI number for Mark Roettger is 1356325906. It was assigned to this individual provider in the NPPES registry on December 6, 2005.

Where is Mark Roettger located?

Mark Roettger practices at 12425 55th Street N Suite B, Lake Elmo, MN 55042. The listed phone number is (651) 439-0322.

What is Mark Roettger's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Mark Roettger enrolled in Medicare?

Yes. Mark Roettger is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mark Roettger's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mark Roettger reassigns Medicare benefits to University Of Minnesota Physicians (Minneapolis, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mark Roettger's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mark Roettger accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Florida Combined Life and Humana and 8 other insurers list Mark Roettger as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Mark Roettger affiliated with any hospitals?

According to CMS data, Mark Roettger is affiliated with M Health Fairview University Of Mn.

When was this NPI record last updated?

The NPPES record for Mark Roettger was last updated on May 11, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years 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.