Keith Bruce McCollister, M.D.

Primary specialty

Neuroradiology PhysicianTaxonomy code 2085N0700X

License

10770 Issued in SD

Practice address

166 4TH St E
Saint Paul, MN 55101-1421

Phone

(651) 292-2000

NPI assigned

Apr 29, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN, WI, SD3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Allina Health System

  dba Allina Health Buffalo Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  Medicare reassignment NPD
• Allina Health System

  dba River Falls Professional Services

  • Emergency Medicine Physician
  • River Falls, WI
  • NPI 1578507513
  Medicare reassignment NPD
• Altru Health System

  dba Altru 1300 Columbia

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  MN

  Medicare reassignment NPD
• Sanford Clinic

  dba Sanford Health Psychiatry & Psychology Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254
  Medicare reassignment NPD
• Allina Health System

  dba Allina Health Senior Health

  • Clinic/Center
  • Minneapolis, MN
  • NPI 1205069325
  NPD
• Allina Health System

  dba Allina Health United Lung & Sleep Clinic

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508105230
  NPD
• Allina Health System

  dba Allina Health TeleRheumatology

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Sanford Clinic

  dba Sanford Virtual Health Services

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345
  NPD
• Sanford Clinic

  dba Sanford Clinic Hospitalists

  • Hospitalist Physician
  • Sioux Falls, SD
  • NPI 1871524207
  NPD

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

{
    "created_epoch": "1240963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541980800000",
    "number": "1427292796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 4TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 4TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011421",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLISTER",
        "first_name": "KEITH",
        "middle_name": "BRUCE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-29",
        "last_updated": "2018-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "SD",
            "license": "10770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427292796",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Jean McCleary, CNM
• Eric McClellan
• Felix McClung, LICSW
• Daniel Robert McClure, PSYD, LP
• Nicole McColley, CRNA
• Kim S McConnell, MD
• William David McConnell, PA-C
• Patti McCool
• Steven E McCormack, MD
• Catherine Monica McCormick-Deaton, D.O.

• Neuroradiology Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Neuroradiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.