Individual provider Active NPI

Jodi L Kreiser, NNP

  • Neonatal Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1508842667
Registry record updated Feb 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
R1289367 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-6000
Fax
(612) 273-4098
NPI assigned
Dec 21, 2005
Last updated
Feb 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X R1289367 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

6465 Wayzata Blvd
Suite 315
St Louis Park, MN 55426-1728

Other practice location 1

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-5208

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
I20050408000643 MN Practitioner - Nurse Practitioner 0345287694 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
629MNMDPodiatrist
R1289367MNMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Mar 1, 2020 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Clinics CurrentSince Mar 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Mar 1, 2020 Accepting new patients
Healtheast Medical Research Institute CurrentSince Mar 1, 2020 Accepting new patients

Locations

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

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

3300 Oakdale Ave N
Apt 180
Robbinsdale, MN 55422
Phone (763) 581-5140

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

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.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581379200000",
    "number": "1508842667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "SUITE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000",
            "fax_number": "612-273-4098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 Excelsior Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554264702",
            "country_code": "US",
            "telephone_number": "952-993-5208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KREISER",
        "first_name": "JODI",
        "middle_name": "L",
        "credential": "NNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "MN",
            "license": "R1289367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.