Kimberly Jo Sedbrook, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11222 Issued in MN

Practice address

2 Carlson Pkwy N Ste 100
Plymouth, MN 55447-4467

Phone

(952) 473-1286

Fax

(952) 473-7281

NPI assigned

Nov 16, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

United Skin Specialists LTDGroup PAC ID 0446558993, 15 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbacharach@center4advderm.emadirect.md

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.

• United Skin Specialists, LTD PC

  • Procedural Dermatology Physician
  • Edina, MN
  • NPI 1861861759
  Medicare reassignment Care Compare group
• Southwest Dermatology Specialists. LTD

  • Dermatology Physician
  • Richfield, MN
  • NPI 1205960317
  NPD
• Central Minnesota Neurosciences LTD

  • Neurological Surgery Physician
  • St. Cloud, MN
  • NPI 1972520773
  NPD (past)
• Infinite Health Collaborative, PA

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1164474250
  NPD (past)
• Infinite Health Collaborative, PA

  • Durable Medical Equipment & Medical Supplies
  • River Falls, WI
  • NPI 1144608589
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1043554868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CARLSON PKWY N STE 240",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474485",
            "telephone_number": "763-367-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CARLSON PKWY N STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474467",
            "telephone_number": "952-473-1286",
            "fax_number": "952-473-7281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 W 50th St",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554241200",
            "country_code": "US",
            "telephone_number": "952-929-8888",
            "fax_number": "952-473-7281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEDBROOK",
        "first_name": "KIMBERLY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-16",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "11222",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3284-23",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004420",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald H Sealock, OD
• Grant Sealock, OD
• Tyler Sealock
• Alison Seamans
• Katherine Ann Searles, DNP, APRN, CPNP-PC
• Anna Sederberg
• Andrew Sedivy, MD
• Peter Lawrence Sedlacek, CRNA
• Athena Seely
• Segal Psychotherapy, LLC

• Physician Assistant in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.