Individual provider Active NPI

Kristin Alta Weimerskirch, PA-C

  • Medical Physician Assistant
  • St Louis Park, MN
National Provider Identifier
1548640527
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
11920 Issued in MN
Practice address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone
(952) 993-3282
NPI assigned
Jun 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Medical Physician Assistant 363AM0700X 11920 MN Primary

Addresses

Primary practice location

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Mailing address

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3282

Other practice location 1

1983 Sloan Place
Suite 11
Saint Paul, MN 55117-2095
Phone (651) 312-1620

Other names 1

  • Kristin Tyler Former name

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
I20150825003620 MN Practitioner - Physician Assistant 2466768205 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

9855 Hospital Dr
Maple Grove, MN 55369-4648
Phone (952) 993-4913

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11920MNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Aug 8, 2015 Accepting new patients
Park Nicollet Clinic CurrentSince Feb 22, 2021 Accepting new patients
Fairview Health Services CurrentSince Aug 8, 2015 Accepting new patients
Infinite Health Collaborative, PA CurrentSince May 1, 2020 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Feb 22, 2021 Accepting new patients
Infinite Health Collaborative, PA CurrentSince May 1, 2020 Accepting new patients
Pelvic Floor Center, LLC Past Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

9855 Hospital Dr
Ste 275
Maple Grove, MN 55369
Phone (763) 981-3200

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

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

1983 Sloan Pl
Ste 11
Saint Paul, MN 55117
Phone (651) 312-1620

1983 Sloan Pl
Ste 7
Saint Paul, MN 55117
Phone (651) 312-1620

6500 Excelsior Blvd
Fl 5
St Louis Park, MN 55426
Phone (952) 993-0377

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

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1548640527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-3282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1983 Sloan Place",
            "address_2": "Suite 11",
            "address_purpose": "LOCATION",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551172095",
            "country_code": "US",
            "telephone_number": "651-312-1620",
            "fax_number": "651-312-1570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEIMERSKIRCH",
        "first_name": "KRISTIN",
        "middle_name": "ALTA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-04",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "11920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "TYLER",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.