NPIMap

Individual provider Active NPI

Krystal Ann Butcher, PA

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1356618359
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-83 Issued in GU
Practice address
2219 Youngman Ave Apt 2
Saint Paul, MN 55116-3016
Phone
(763) 204-1544
NPI assigned
Nov 19, 2011
Last updated
Oct 23, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 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 PA-83 GU Primary

Addresses

Primary practice location

2219 Youngman Ave Apt 2
Saint Paul, MN 55116-3016

Mailing address

736 Route 4
Ste. 103
Sinajana, GUAM 96910
UM
Phone (671) 649-7232

Other practice location 1

736 Route 4
Ste. 103
Sinajana, Guam 96910
UM
Phone (671) 649-7232

Other names 1

  • Krystal Ann King Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GU, MN2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20160317001073 GU Practitioner - Physician Assistant 4789980764 Reassigns benefits to 1 organization
I20231228002415 MN Practitioner - Physician Assistant 4789980764 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Specialists of Minnesota, PAGroup PAC ID 5092616029, 33 clinicians

Practice addresses (Care Compare)

6200 Shingle Creek Pkwy
Suite 250
Brooklyn Center, MN 55430-2107
Phone (763) 544-0696

6601 Lyndale Ave S
Suite 220
Richfield, MN 55423-2493
Phone (612) 823-8001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
71.42 of 100Reported as group
Quality
34.49
Improvement activities
40
Cost
75.41

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince Dec 1, 2023 Accepting new patients
North Memorial Health Care CurrentSince Dec 1, 2023 Accepting new patients
Ilbnc, P.a. Past Accepting new patients
Advanced Eyecare, LLC Past Accepting new patients

Locations

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

Interoperability endpoints

  • Direct secure messaging: kbutcher60143@direct.acumenmd.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1321660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1356618359",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "736 ROUTE 4",
            "address_2": "STE. 103",
            "city": "SINAJANA",
            "state": "GUAM",
            "postal_code": "96910",
            "telephone_number": "671-649-7232",
            "fax_number": "671-649-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 YOUNGMAN AVE APT 2",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551163016",
            "telephone_number": "763-204-1544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "736 Route 4",
            "address_2": "Ste. 103",
            "address_purpose": "LOCATION",
            "city": "Sinajana",
            "state": "Guam",
            "postal_code": "96910",
            "country_code": "UM",
            "telephone_number": "671-649-7232",
            "fax_number": "671-649-7233",
            "country_name": "United States Minor Outlying Islands",
            "address_type": "FGN"
        }
    ],
    "basic": {
        "last_name": "BUTCHER",
        "first_name": "KRYSTAL",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-19",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GU",
            "license": "PA-83",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "KING",
            "middle_name": "ANN",
            "credential": "MAIDEN NAME",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.