Individual provider Active NPI

Michael Kehoe, LICSW

  • Clinical Social Worker
  • Eagan, MN
National Provider Identifier
1184718165
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10311 Issued in MN
Practice address
3450 Oleary LN
Eagan, MN 55123-2340
Phone
(651) 454-0114
Fax
(651) 454-3492
NPI assigned
Oct 3, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 10311 MN Primary

Addresses

Primary practice location

3450 Oleary LN
Eagan, MN 55123-2340

Mailing address

1730 Hillcrest Ave
Saint Paul, MN 55116-2151

Other identifiers 3

IdentifierTypeStateIssuer
59280EAOtherMNBCBS
62-26779OtherMNUBH
HP20105OtherMNHEALTHPARTNERS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111212000921 MN Practitioner - Clinical Social Worker 3577738087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

2215 E Lake St
Minneapolis, MN 55407-4385
Phone (612) 596-9438

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin County Clinical CurrentSince Dec 13, 2013 Accepting new patients
Hennepin County CurrentSince Dec 13, 2013 Accepting new patients

Locations

1801 Nicollet Ave
Minneapolis, MN 55403
Phone (612) 596-0900

2215 E Lake St
Minneapolis, MN 55407
Phone (612) 596-0900

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184718165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 HILLCREST AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 OLEARY LN",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232340",
            "telephone_number": "651-454-0114",
            "fax_number": "651-454-3492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEHOE",
        "first_name": "MICHAEL",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "10311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "59280EA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "62-26779",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP20105",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.