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Individual provider Active NPI

Michelle Ann Killam, APRN

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1295428019
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10228 Issued in MN
Practice address
3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761
Phone
(763) 587-7737
Fax
(763) 587-7069
NPI assigned
May 29, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10228 MN
Family Nurse Practitioner 363LF0000X 10228 MN Primary

Addresses

Primary practice location

3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761

Mailing address

3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737

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
I20230707002478 MN Practitioner - Nurse Practitioner 4981063005 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geriatric Services of Minnesota LLCGroup PAC ID 2365667557, 44 clinicians
Genevive Aco LLCGroup PAC ID 8628585080, 43 clinicians

Practice addresses (Care Compare)

3433 Broadway St NE
Suite 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737

Hospital & facility affiliations

  • Centracare Health - Monticello Hospital, Monticello, MN, CCN 241362
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • Cura of Monticello Nursing home, Monticello, MN, CCN 245511

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10228MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatric Services of Minnesota, LLC CurrentSince Jun 27, 2023 Accepting new patients
Genevive Aco LLC CurrentSince Sep 1, 2025 Accepting new patients

Locations

715 1st St N
Cold Spring, MN 56320
Phone (320) 685-3693

3433 Broadway St NE
Ste 300
Minneapolis, MN 55413

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1685318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1295428019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131761",
            "telephone_number": "763-587-7737",
            "fax_number": "763-587-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131761",
            "telephone_number": "763-587-7737",
            "fax_number": "763-587-7069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLAM",
        "first_name": "MICHELLE",
        "middle_name": "ANN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-29",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "10228",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "10228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.