NPIMap

Individual provider Active NPI

John Curtis Kelly, PA-C

  • Physician Assistant
  • Stillwater, MN
National Provider Identifier
1528470341
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13315 Issued in MN
Practice address
1701 Curve Crest Blvd W Ste 104
Stillwater, MN 55082-6181
Phone
(651) 439-8807
Fax
(652) 439-0232
NPI assigned
May 28, 2014
Last updated
May 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-005039 IL
Physician Assistant 363A00000X 13315 MN Primary

Addresses

Primary practice location

1701 Curve Crest Blvd W Ste 104
Stillwater, MN 55082-6181

Mailing address

1701 Curve Crest Blvd W Ste 104
Stillwater, MN 55082-6181
Phone (651) 439-8807

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MN, WI3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140618001778 IL Practitioner - Physician Assistant 2163646886 Reassigns benefits to 1 organization
I20200608001949 MN Practitioner - Physician Assistant 2163646886 Reassigns benefits to 1 organization
I20200612001662 WI Practitioner - Physician Assistant 2163646886 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians
Westfields Hospital IncGroup PAC ID 2264490960, 108 clinicians

Practice addresses (Care Compare)

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone (952) 831-8742

155 Radio Dr
Woodbury, MN 55125-2619
Phone (952) 831-8742

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-005039ILMDPhysician Assistant
13315MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tria Orthopaedic Center LLC CurrentSince Sep 19, 2022 Accepting new patients
Westfields Hospital, Inc CurrentSince Jul 25, 2020 Accepting new patients
Swedish Covenant Management Services, Inc. Physician Assistant CurrentSince Aug 29, 2016 Accepting new patients
Westfields Hospital, Inc. CurrentSince Jul 25, 2020 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
Hudson Hospital, Inc Past Accepting new patients
Lakeview Memorial Hospital Association Inc. Past Accepting new patients

Locations

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

5145 N California Ave
Chicago, IL 60625
Phone (773) 989-3800

5145 N California Ave
#M331M274
Chicago, IL 60625

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

Interoperability endpoints

  • Direct secure messaging: jkelly267241@direct.healthpartners.com

Organizations & group practices 8

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 7

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": "1401235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1528470341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CURVE CREST BLVD W STE 104",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826181",
            "telephone_number": "651-439-8807",
            "fax_number": "652-439-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CURVE CREST BLVD W STE 104",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826181",
            "telephone_number": "651-439-8807",
            "fax_number": "652-439-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "middle_name": "CURTIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-28",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-005039",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.