Individual provider Active NPI

Katherine Moody, P.A.

  • Physician Assistant
  • Edina, MN
National Provider Identifier
1194809400
Registry record updated Aug 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10589 Issued in MN
Practice address
6405 France Ave S
Suite W200
Edina, MN 55435-2163
Phone
(952) 924-9005
Fax
(952) 915-2443
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2009

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 085-002505 IL
Physician Assistant 363A00000X 10589 MN Primary

Addresses

Primary practice location

6405 France Ave S
Suite W200
Edina, MN 55435-2163

Mailing address

6405 France Ave S
Suite W200
Edina, MN 55435-2163
Phone (952) 924-9005

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090608000387 MN Practitioner - Physician Assistant 0042243644 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

14101 Fairview Dr
Suite 140
Burnsville, MN 55337-2515
Phone (612) 365-5000

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

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

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

Hospital & facility affiliations

  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
  • Fairview Lakes Health Services Hospital, Wyoming, MN, CCN 240050
  • M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-002505ILMDMedical Physician Assistant
10589MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Jul 7, 2024 Accepting new patients
Fairview Health Services CurrentSince Jun 8, 2009 Accepting new patients
Fairview Health Services CurrentSince Jun 8, 2009 Accepting new patients
Prairie Cardiovascular Consultants LTD Past Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

6405 France Ave S
Ste W200
Minneapolis, MN 55435
Phone (952) 836-3700

6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

919 Northland Dr
Princeton, MN 55371
Phone (763) 389-3344

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

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

Interoperability endpoints

  • Direct secure messaging: kmoody5352@fairview.direct-ci.com

Organizations & group practices 8

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 5

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250121600000",
    "number": "1194809400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 FRANCE AVE S",
            "address_2": "SUITE W200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352163",
            "telephone_number": "952-924-9005",
            "fax_number": "952-915-2443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 FRANCE AVE S",
            "address_2": "SUITE W200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352163",
            "telephone_number": "952-924-9005",
            "fax_number": "952-915-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "KATHERINE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2009-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-002505",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.