NPIMap

Individual provider Active NPI

Kelli Bronder, APRN,CNP,RN

  • Gerontology Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1053073866
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
8617 Issued in MN
Practice address
3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761
Phone
(763) 587-7737
Fax
(763) 587-7069
NPI assigned
Oct 8, 2021
Last updated
May 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 8617 MN
Gerontology Nurse Practitioner 363LG0600X 8617 MN Primary

Addresses

Primary practice location

3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761

Mailing address

3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220721003893 MN Practitioner - Nurse Practitioner 4587045570 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geriatric Services of Minnesota LLCGroup PAC ID 2365667557, 44 clinicians
Genevive Aco LLCGroup PAC ID 8628585080, 43 clinicians

Practice addresses (Care Compare)

3433 Broadway St NE
Suite 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Genevive Aco LLC CurrentSince Sep 1, 2025 Accepting new patients
Geriatric Services of Minnesota, LLC CurrentSince Apr 9, 2022 Accepting new patients

Locations

715 1st St N
Cold Spring, MN 56320
Phone (320) 685-3693

3433 Broadway St NE
Ste 300
Minneapolis, MN 55413

1115 4th Ave N
Sauk Rapids, MN 56379
Phone (320) 252-6525

Organizations & group practices 2

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

Hospital & facility affiliations 9

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": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1053073866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131761",
            "telephone_number": "763-587-7737",
            "fax_number": "763-587-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131761",
            "telephone_number": "763-587-7737",
            "fax_number": "763-587-7069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONDER",
        "first_name": "KELLI",
        "credential": "APRN,CNP,RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "8617",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "8617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.