NPIMap

Individual provider Active NPI

Roy Kagumba Kiberenge, M.D.

  • Critical Care Medicine (Anesthesiology) Physician
  • Minneapolis, MN
National Provider Identifier
1215254784
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
License
62855 Issued in MN
Practice address
800 E 28TH St
Minneapolis, MN 55407-3723
Phone
(612) 863-4762
Fax
(612) 863-8425
NPI assigned
Apr 23, 2010
Last updated
Mar 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 055554 CT
Anesthesiology Physician 207L00000X 41888 IA
Anesthesiology Physician 207L00000X 290680 MA
Anesthesiology Physician 207L00000X 62855 MN
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 62855 MN Primary

Addresses

Primary practice location

800 E 28TH St
Minneapolis, MN 55407-3723

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rkiberenge600206@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, MA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20171017000158 MN Practitioner - Anesthesiology 2769608587 Reassigns benefits to 4 organizations
I20220525002747 MA Practitioner - Anesthesiology 2769608587 Reassigns benefits to 3 organizations
I20230413000967 MN Practitioner - Critical Care (Intensivists)Practitioner - Anesthesiology 2769608587 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Vanderbilt University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians
University Anesthesia Providers LLCGroup PAC ID 7315986064, 325 clinicians
Anesthesiology, P.a.Group PAC ID 9335033034, 136 clinicians
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

101 Page St
New Bedford, MA 02740-3464
Phone (508) 973-5919

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 273-4097

3300 N Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 520-5370

800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-4762

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
055554CTMDAnesthesiology Physician
41888IAMDAnesthesiology Physician
62855MNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Apr 27, 2022 Accepting new patients
Allina Health System CurrentSince Sep 26, 2022 Accepting new patients
Minnesota Valley Health Center Inc CurrentSince Dec 12, 2022 Accepting new patients
Allina Health System Current Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Feb 19, 2024 Accepting new patients
Ridgeview Medical Center Current Accepting new patients
Metropolitan Anesthesia Network, LLP Anesthesiology CurrentSince Dec 1, 2022 Accepting new patients
University Anesthesia Providers, LLC Anesthesiology CurrentSince Aug 31, 2017 Accepting new patients
Minnesota Valley Health Center Inc Current Accepting new patients
Sibley Medical Center CurrentSince Dec 12, 2022 Accepting new patients
Massachusetts General Physicians Organization Inc Critical Care Medicine CurrentSince Apr 27, 2022 Accepting new patients
Ridgeview Medical Center CurrentSince Dec 12, 2022 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Feb 19, 2024 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
#437
Boston, MA 02114
Phone (617) 643-2652

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

601 W Chandler St
Arlington, MN 55307
Phone (507) 964-2271

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

621 S 4th St
Le Sueur, MN 56058
Phone (507) 665-3375

13601 80th Cir N
Ste 100
Maple Grove, MN 55369
Phone (612) 219-5355

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

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

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

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

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

Interoperability endpoints

  • Direct secure messaging: rkiberenge407727@fairview.direct-ci.com
  • Direct secure messaging: rkiberenge77552@direct.southcoast.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1215254784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 28TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073723",
            "telephone_number": "612-863-4762",
            "fax_number": "612-863-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBERENGE",
        "first_name": "ROY",
        "middle_name": "KAGUMBA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-23",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "055554",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IA",
            "license": "41888",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "290680",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "62855",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "MN",
            "license": "62855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkiberenge600206@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "800 E 28th St",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554073723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.