NPIMap

Individual provider Active NPI

Elizabeth Maureen Kennedy Laliberte, PA-C

  • Physician Assistant
  • Shakopee, MN
National Provider Identifier
1063500247
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10163 Issued in MN
Practice address
1601 Saint Francis Ave Ste 100
Shakopee, MN 55379-3384
Phone
(952) 403-3535
Fax
(950) 403-3599
NPI assigned
Oct 11, 2006
Last updated
Sep 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10163 MN Primary
Medical Physician Assistant 363AM0700X 10163 MN

Addresses

Primary practice location

1601 Saint Francis Ave Ste 100
Shakopee, MN 55379-3384

Mailing address

1601 Saint Francis Ave Ste 100
Shakopee, MN 55379-3384
Phone (952) 403-3535

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
I20070116000237 MN Practitioner - Physician Assistant 9638170749 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

1455 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (651) 635-9173

1601 Saint Francis Ave
Suite 100
Shakopee, MN 55379-3384
Phone (952) 428-3535

2925 Chicago Ave
Minneapolis, MN 55407-1321

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10163MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
NPI 1083910871 Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

1601 Saint Francis Ave
Ste 100
Shakopee, MN 55379
Phone (952) 403-3535

Interoperability endpoints

  • Direct secure messaging: ekennedy59023@excellian.direct.allina.com

Organizations & group practices 6

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1063500247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 SAINT FRANCIS AVE STE 100",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793384",
            "telephone_number": "952-403-3535",
            "fax_number": "950-403-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SAINT FRANCIS AVE STE 100",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793384",
            "telephone_number": "952-403-3535",
            "fax_number": "950-403-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY LALIBERTE",
        "first_name": "ELIZABETH",
        "middle_name": "MAUREEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10163",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "10163",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

Verify at the official NPI Registry.