Individual provider Active NPI

Richard Joseph Kubicka, M.D.

  • Vascular Surgery Physician
  • Princeton, MN
National Provider Identifier
1255369989
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
46028 Issued in MN
Practice address
919 Northland Dr
Princeton, MN 55371-2172
Phone
(763) 389-3344
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 46028 MN Primary
Specialist 174400000X 46028 MN
Surgery Physician 208600000X 46028 MN

Addresses

Primary practice location

919 Northland Dr
Princeton, MN 55371-2172

Mailing address

1700 University Ave W
Saint Paul, MN 55104-3727

Other practice location 1

290 Main St NW
Suite 100
Elk River, MN 55330-1270
Phone (763) 241-0373

Other identifiers 1

IdentifierTypeStateIssuer
260491400MedicaidMN

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041216000623 MN Practitioner - Vascular SurgeryPractitioner - General Surgery 1759348170 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Rutgers New Jersey Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

14500 99TH Ave N
Suite 100
Maple Grove, MN 55369-4738
Phone (763) 898-1000

Hospital & facility affiliations

  • Fairview Northland Regional Hospital Hospital, Princeton, MN, CCN 240141
  • Fairview Lakes Health Services Hospital, Wyoming, MN, CCN 240050

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy25
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux11
Varicose vein removal1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46028MNMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Clinics CurrentSince Jun 14, 2014 Accepting new patients
Fairview Express Care Current Accepting new patients
Range Regional Health Services Current Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Jul 14, 2014 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Health Services CurrentSince Jul 14, 2014 Accepting new patients
Range Regional Health Services CurrentSince Dec 31, 2020 Accepting new patients
Range Regional Health Services CurrentSince Dec 31, 2020 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

6405 France Ave S
Ste W320
Edina, MN 55435
Phone (952) 915-8626

6405 France Ave S
Ste 440
Edina, MN 55435
Phone (952) 927-7004

290 Main St NW
Ste 100
Elk River, MN 55330
Phone (763) 241-0373

3605 Mayfair Ave
Hibbing, MN 55746
Phone (218) 262-3441

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

12680 Arbor Lakes Pkwy N
Maple Grove, MN 55369
Phone (763) 488-8346

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

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

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

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

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

Interoperability endpoints

  • Direct secure messaging: rkubicka10397@fairview.direct-ci.com

Organizations & group practices 12

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 2

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1255369989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712172",
            "telephone_number": "763-389-3344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 Main St NW",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Elk River",
            "state": "MN",
            "postal_code": "553301270",
            "country_code": "US",
            "telephone_number": "763-241-0373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUBICKA",
        "first_name": "RICHARD",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MN",
            "license": "46028",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "46028",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "46028",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260491400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, MN

Sources for this page

Verify at the official NPI Registry.