Individual provider Active NPI

Kyle Jeffrey Theilmann, PA-C

  • Physician Assistant
  • Maple Grove, MN
National Provider Identifier
1306522768
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14548 Issued in MN
Practice address
9630 Grove Cir N Ste 200
Maple Grove, MN 55369-3492
Phone
(763) 520-7870
NPI assigned
Jun 22, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14548 MN Primary

Addresses

Primary practice location

9630 Grove Cir N Ste 200
Maple Grove, MN 55369-3492

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

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
I20230822001290 MN Practitioner - Physician Assistant 2961864038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

16800 37TH PL N
Plymouth, MN 55446-2805
Phone (763) 520-7870

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

3366 Oakdale Ave N
Suite 103
Robbinsdale, MN 55422-2961
Phone (763) 520-7870

9630 Grove Cir N
Suite 200
Maple Grove, MN 55369-3492
Phone (763) 520-7870

Hospital & facility affiliations

  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001
  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14548MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Sep 18, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Sep 18, 2023 Accepting new patients
North Memorial Health Care CurrentSince Sep 1, 2024 Accepting new patients
North Memorial Health Care CurrentSince Sep 1, 2024 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

9630 Grove Cir N
Ste 200
Maple Grove, MN 55369
Phone (763) 520-7580

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

7866 12th Ave S
Minneapolis, MN 55425

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

16800 37th Pl N
#200
Plymouth, MN 55446
Phone (635) 207-8707

3366 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 287-5000

3366 Oakdale Ave N
Ste 103
Robbinsdale, MN 55422

Organizations & group practices 7

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": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1306522768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9630 GROVE CIR N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553693492",
            "telephone_number": "763-520-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEILMANN",
        "first_name": "KYLE",
        "middle_name": "JEFFREY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.