Kimberly Knowles Deroche, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41601 Issued in MN

Practice address

2849 Johnson St NE
Minneapolis, MN 55418-3055

Phone

(612) 706-4500

NPI assigned

Mar 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Ann Knowles Other name

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

Specialty

Family Practice

Education

University of Minnesota Medical School, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kderoche6733@fairview.direct-ci.com

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.

• Fairview Clinics

  • Primary Care Clinic/Center
  • Minneapolis, MN
  • NPI 1346432218
  Medicare reassignment Care Compare group NPD
• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment NPD
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Fairview Clinics

  • Primary Care Clinic/Center
  • Rogers, MN
  • NPI 1124210760
  NPD
• Fairview Clinics

  • Primary Care Clinic/Center
  • Saint Paul, MN
  • NPI 1396552147
  NPD
• Fairview Express Care

  • Sleep Disorder Diagnostic Clinic/Center
  • Minneapolis, MN
  • NPI 1194143024
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Fairview Health Services

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD
• Fairview Health Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD

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

• Fairview Health Services

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  Care Compare affiliation
• Fairview Health Services

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1316008212
  Care Compare affiliation
• Fairview Health Services

  • Skilled Nursing Facility
  • Minneapolis, MN
  • NPI 1669459913

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1386611150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2849 JOHNSON ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2849 JOHNSON ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183055",
            "telephone_number": "612-706-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROCHE",
        "first_name": "KIMBERLY",
        "middle_name": "KNOWLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "KNOWLES",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Terryl Derimanoczy
• Margaret Mary Dering
• Riley James Derks
• Derman Senior Care
• Derman Transportation Inc
• Michelle Elaine Derome
• Beth Deronne
• Sarah Derosier, DPT
• Sarah Kae Derr, PHARM.D.
• Mark Deruiter, PH.D.

• Family Medicine Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.