Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jeffrey Charles Otis, PA-C

Individual provider Physician Assistant · NPI 1649720533

Jeffrey Charles Otis, PA-C is a Physician Assistant in Saint Paul, Minnesota. Qualified in 2016, 10 years ago. Practices with Group Health Plan Inc, a 1,633-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
10
Licensed in
MN
In the registry since
2016
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

640 Jackson St
Saint Paul, MN 55101-2502
Phone: (651) 254-4887
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12288 (MN)

Record details

NPI number1649720533
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 4, 2016
Last updated in NPPESMay 19, 2022
Certification dateMay 19, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Group Health Plan Inc — 1633 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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