NPIMap

Individual provider Active NPI

Alyssa Kettler

  • Emergency Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1518594092
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
78809 Issued in MN
Practice address
640 Jackson St # T
Saint Paul, MN 55101-2502
Phone
(651) 254-3456
NPI assigned
Mar 25, 2020
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 78809 MN Primary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X A187029 CA

Addresses

Primary practice location

640 Jackson St # T
Saint Paul, MN 55101-2502

Mailing address

1000 W Carson St
Torrance, CA 90502-2004
Phone (310) 222-2345

Other practice location 1

927 Churchill St W
Stillwater, MN 55082-6605
Phone (651) 430-4529

Other practice location 2

1000 W Carson St
Torrance, CA 90502-2004
Phone (310) 222-2345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250911001965 MN Practitioner - Emergency Medicine 3274036793 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Western Michigan Un Homer Stryker School of Med, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5901 Lincolin Dr
Edina, MN 55436-1611

8170 33Rd Ave
Ms 21110Q
Bloomington, MN 55425-1614

8170 33Rd Ave S
Bloomington, MN 55425-1614

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A187029CAMDPediatric Emergency Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care CurrentSince Jan 13, 2026 Accepting new patients
Regions Hospital CurrentSince Aug 4, 2025 Accepting new patients
Regions Hospital Emergency Medicine CurrentSince Aug 4, 2025 Accepting new patients
Lakeview Memorial Hospital Association Inc CurrentSince Aug 18, 2025 Accepting new patients
Lakeview Memorial Hospital Association Inc. Emergency Medicine CurrentSince Aug 18, 2025 Accepting new patients
Childrens Health Care CurrentSince Jan 13, 2026 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

640 Jackson St
#T
Saint Paul, MN 55101
Phone (651) 254-3456

927 Churchill St W
Stillwater, MN 55082
Phone (651) 430-4529

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1518594092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022004",
            "telephone_number": "310-222-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST # T",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "927 Churchill St W",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "MN",
            "postal_code": "550826605",
            "country_code": "US",
            "telephone_number": "651-430-4529",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W Carson St",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905022004",
            "country_code": "US",
            "telephone_number": "310-222-2345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTLER",
        "first_name": "ALYSSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "78809",
            "primary": true
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "CA",
            "license": "A187029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.