Individual provider Active NPI

John L Kipp, M.D.

  • Occupational Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1366427601
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
25028 Issued in MN
Practice address
1661 Saint Anthony Ave
Saint Paul, MN 55104-3733
Phone
(651) 968-5300
Fax
(651) 646-0205
NPI assigned
Dec 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Physician 2083X0100X 25028 MN Primary

Addresses

Primary practice location

1661 Saint Anthony Ave
Saint Paul, MN 55104-3733

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5042

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
I20090128000421 MN Practitioner - Internal Medicine 5092879502 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25028MNMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Orthopedics, LTD CurrentSince Jul 1, 2014 Accepting new patients
Summit Orthopedics LTD CurrentSince Jul 1, 2014 Accepting new patients
Summit Orthopedics, LTD. Past Accepting new patients
Summit Orthopedics, LTD. Past Accepting new patients

Locations

10230 Baltimore St NE
#300
Blaine, MN 55449
Phone (651) 968-5300

1400 Corporate Center Curv
Ste 200
Eagan, MN 55121
Phone (519) 685-3006

1661 Saint Anthony Ave
Saint Paul, MN 55104
Phone (651) 968-5300

1661 Saint Anthony Ave
Fl 1
Saint Paul, MN 55104
Phone (651) 968-5600

710 Commerce Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5042

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1366427601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925",
            "telephone_number": "651-968-5042",
            "fax_number": "651-968-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 SAINT ANTHONY AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043733",
            "telephone_number": "651-968-5300",
            "fax_number": "651-646-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIPP",
        "first_name": "JOHN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MN",
            "license": "25028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.