NPIMap

Individual provider Active NPI

Elizabeth Jean Krebsbach

  • Gerontology Nurse Practitioner
  • Golden Valley, MN
National Provider Identifier
1194387902
Registry record updated Nov 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
6661 Issued in MN
Practice address
1415 Lilac Dr N Ste 190
Golden Valley, MN 55422-4544
Phone
(763) 267-8701
Fax
(763) 231-9602
NPI assigned
Jul 1, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 6661 MN Primary

Addresses

Primary practice location

1415 Lilac Dr N Ste 190
Golden Valley, MN 55422-4544

Mailing address

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

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
I20190715001344 MN Practitioner - Nurse Practitioner 5991030843 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of North Dakota School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Specialty ServicesGroup PAC ID 3072083286, 303 clinicians
Healtheast Medical Research InstituteGroup PAC ID 3971407636, 665 clinicians
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1655 Beam Ave
Suite 111
Maplewood, MN 55109-1475
Phone (855) 324-7843

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

Hospital & facility affiliations

  • M Health Fairview St John'S Hospital Hospital, Maplewood, MN, CCN 240210
  • M Health Fairview Woodwinds Hospital Hospital, Woodbury, MN, CCN 240213
  • Fairview Lakes Health Services Hospital, Wyoming, MN, CCN 240050
  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

Merit-based Incentive Payment System (MIPS)

Final score
92.68 of 100Reported as group
Quality
89.73
Promoting interoperability
100
Improvement activities
40
Cost
80.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute CurrentSince May 7, 2022 Accepting new patients
Fairview Express Care Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Twin Cities Physicians Professional Corporation CurrentSince Jul 1, 2019 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2025 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2025 Accepting new patients
Healtheast Medical Research Insititue CurrentSince May 7, 2022 Accepting new patients
Healtheast Medical Research Institute Past Accepting new patients

Locations

1655 Beam Ave
Ste 111
Maplewood, MN 55109
Phone (651) 232-7770

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

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

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

17 Exchange St W
Ste 835
Saint Paul, MN 55102
Phone (651) 232-4200

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

Interoperability endpoints

  • Direct secure messaging: ekrebsbach196338@fairview.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 7

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": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1194387902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 LILAC DR N STE 190",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224544",
            "telephone_number": "763-267-8701",
            "fax_number": "763-231-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 LILAC DR N STE 190",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224544",
            "telephone_number": "763-267-8701",
            "fax_number": "763-231-9602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREBSBACH",
        "first_name": "ELIZABETH",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "6661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

Verify at the official NPI Registry.