Individual provider Active NPI

Kailey Immen, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1023739141
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14189 Issued in MN
Practice address
500 Harvard St SE
Minneapolis, MN 55455-0363
Phone
(507) 380-6474
NPI assigned
Sep 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14189 MN Primary

Addresses

Primary practice location

500 Harvard St SE
Minneapolis, MN 55455-0363

Mailing address

412 E Main St
Arlington, MN 55307-2042
Phone (507) 380-6474

Other practice location 1

1620 W Harrison St
Chicago, IL 60612-3801
Phone (507) 380-6474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221103000119 MN Practitioner - Physician Assistant 1456728591 Reassigns benefits to 8 organizations
I20250226003492 IL Practitioner - Physician Assistant 1456728591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1620 W Harrison St
Chicago, IL 60612-3801

1653 W Congress Pkwy
Chicago, IL 60612-3833

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

1725 W Harrison St
Chicago, IL 60612-3849

1725 W Harrison St
Suite 450
Chicago, IL 60612-4828
Phone (312) 563-4238

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

  • Rush University Medical Center Hospital, Chicago, IL, CCN 140119
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080
  • Rush Oak Park Hospital Hospital, Oak Park, IL, CCN 140063

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Merit-based Incentive Payment System (MIPS)

Final score
96.93 of 100Reported as group
Quality
94.88
Promoting interoperability
100
Improvement activities
40
Cost
78.21

Merit-based Incentive Payment System (MIPS)

Final score
92.35 of 100Reported as group
Quality
88.69
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Range Regional Health Services CurrentSince Mar 1, 2023 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Nov 17, 2022 Accepting new patients
Fairview Health Services CurrentSince Nov 1, 2022 Accepting new patients
Healtheast Medical Research Institute CurrentSince Nov 1, 2022 Accepting new patients
Rush University Medical Center CurrentSince Feb 19, 2025 Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2022 Accepting new patients
Fairview Health Services CurrentSince Nov 1, 2022 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Dec 1, 2022 Accepting new patients
Fairview Express Care CurrentSince Nov 1, 2022 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Nov 1, 2022 Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2022 Accepting new patients
Range Regional Health Services CurrentSince Mar 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Nov 1, 2022 Accepting new patients
Rush University Medical Group CurrentSince Feb 19, 2025 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1725 W Harrison St
Ste 1159
Chicago, IL 60612
Phone (312) 942-5020

1725 W Harrison St
Ste 358
Chicago, IL 60612
Phone (312) 563-5020

1411 S Michigan Ave
Chicago, IL 60605
Phone (312) 454-2700

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

909 Fulton St SE
Ste 318
Minneapolis, MN 55455

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

6401 University Ave NE
Minneapolis, MN 55432
Phone (763) 572-5706

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Interoperability endpoints

  • Direct secure messaging: kgeib717329@fairview.direct-ci.com

Organizations & group practices 22

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 22

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1023739141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 E MAIN ST",
            "city": "ARLINGTON",
            "state": "MN",
            "postal_code": "553072042",
            "telephone_number": "507-380-6474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HARVARD ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550363",
            "telephone_number": "507-380-6474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1620 W Harrison St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123801",
            "country_code": "US",
            "telephone_number": "507-380-6474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMMEN",
        "first_name": "KAILEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.