Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Thomas Jacob Butenhoff, MPAS, PA-C

Individual provider Physician Assistant · NPI 1215781109

Thomas Jacob Butenhoff, MPAS, PA-C is a Physician Assistant in Burnsville, Minnesota. Qualified in 2023, 3 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
3
Licensed in
MN
In the registry since
2024
Specialties on file
3
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

14000 Fairview Dr
Burnsville, MN 55337-5713
Phone: (952) 993-8700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 402 University Ave E, Saint Paul, MN 55130-4400 — (651) 266-4009

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14787 (MN)
Physician Assistant Taxonomy 363A00000X
Medical Physician Assistant Taxonomy 363AM0700X · Licence 14787 (MN)

Record details

NPI number1215781109
Entity typeIndividual (Type 1)
GenderMale
Credentials MPAS , PA-C
Sole proprietorNo
NPI enumeratedApril 16, 2024
Last updated in NPPESFebruary 19, 2025
Certification dateFebruary 19, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Burnsville