NPIMap

Individual provider Active NPI

Kristy Jordan Lichtenberg, PA

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1134637986
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12632 Issued in MN
Practice address
225 Smith Ave N
Ste 200
St Paul, MN 55102-2697
Phone
(651) 241-5111
Fax
(651) 241-5512
NPI assigned
Jan 15, 2018
Last updated
Dec 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 12632 MN Primary

Addresses

Primary practice location

225 Smith Ave N
Ste 200
St Paul, MN 55102-2697

Mailing address

2925 Chicago Avenue
Minneapolis, MN 55407-1321
Phone (612) 262-5000

Other practice location 1

6565 France Ave S Ste 375
Edina, MN 55435-2141
Phone (651) 312-1700

Other practice location 2

1415 Lilac Dr N Ste 190
Golden Valley, MN 55422-4544
Phone (763) 267-8701

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address klichtenberg265479@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180327001984 MN Practitioner - Physician Assistant 4587926704 Reassigns benefits to 3 organizations
I20230712003485 WI Practitioner - Physician Assistant 4587926704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

225 Smith Ave N
3Rd FL
St Paul, MN 55102-2383
Phone (612) 775-6200

2925 Chicago Ave
Minneapolis, MN 55407-1321

310 Smith Ave N
Suite 300
St Paul, MN 55102-2383
Phone (952) 946-9777

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6000

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

9055 Springbrook Dr NW
Coon Rapids, MN 55433-5841
Phone (763) 780-9155

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12632MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince May 1, 2020 Accepting new patients
Allina Health System CurrentSince Aug 28, 2023 Accepting new patients
Allina Health System CurrentSince Oct 1, 2023 Accepting new patients
Allina Health System CurrentSince Aug 28, 2023 Accepting new patients
Allina Health System CurrentSince Aug 28, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince May 1, 2020 Accepting new patients
Allina Health System Past Accepting new patients

Locations

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

11850 Blackfoot St NW
Ste 290
Coon Rapids, MN 55433
Phone (763) 236-0808

11850 Blackfoot St NW
Ste 300
Minneapolis, MN 55433
Phone (763) 236-0808

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

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

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

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

6565 France Ave S
Ste 375
Minneapolis, MN 55435
Phone (651) 312-1700

225 Smith Ave N
Ste 200
Saint Paul, MN 55102
Phone (651) 241-5111

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Interoperability endpoints

  • Direct secure messaging: klichtenberg265479@excellian.direct.allina.com

Organizations & group practices 10

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 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1134637986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVENUE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SMITH AVE N",
            "address_2": "STE 200",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "551022697",
            "telephone_number": "651-241-5111",
            "fax_number": "651-241-5512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6565 France Ave S Ste 375",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554352141",
            "country_code": "US",
            "telephone_number": "651-312-1700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1415 Lilac Dr N Ste 190",
            "address_purpose": "LOCATION",
            "city": "Golden Valley",
            "state": "MN",
            "postal_code": "554224544",
            "country_code": "US",
            "telephone_number": "763-267-8701",
            "fax_number": "763-231-9602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICHTENBERG",
        "first_name": "KRISTY",
        "middle_name": "JORDAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-15",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klichtenberg265479@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "225 Smith Ave N",
            "address_2": "STE 200",
            "city": "St Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551022697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.