NPIMap

Individual provider Active NPI

Jyothi Bhanu Kesha, M.D.

  • Urology Physician
  • Fridley, MN
National Provider Identifier
1558358796
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
42668 Issued in MN
Practice address
500 Osborne Rd NE
Suite 240
Fridley, MN 55432-2765
Phone
(763) 783-8582
Fax
(763) 783-8616
NPI assigned
Oct 3, 2005
Last updated
Oct 13, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 42668 MN Primary

Addresses

Primary practice location

500 Osborne Rd NE
Suite 240
Fridley, MN 55432-2765

Mailing address

2550 University Ave W
Suite 240N
Saint Paul, MN 55114-1052
Phone (651) 999-6909

Other identifiers 1

IdentifierTypeStateIssuer
307127800MedicaidMN

Other names 1

  • Miss Jyothi Bhanu Former name

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
I20050509000901 MN Practitioner - Urology 3577503515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1992
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)

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (952) 993-7750

15111 Twelve Oaks Ctr Dr
Minnetonka, MN 55305-5201
Phone (952) 993-4500

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

250 Central Ave N
Wayzata, MN 55391-1206
Phone (952) 993-3123

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

3900 Park Nicollet Blvd
St Louis Park, MN 55416-2503
Phone (952) 993-3123

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42668MNMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Jun 1, 2008 Accepting new patients
Park Nicollet Clinic CurrentSince Jun 1, 2008 Accepting new patients
Metropolitan Urologic Specialists. P.a. Past Accepting new patients
Minnesota Urology, PA Urology Past Accepting new patients

Locations

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

2550 University Ave W
Ste 240N
Saint Paul, MN 55114

5400 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20581/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1558358796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "address_2": "SUITE 240N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141052",
            "telephone_number": "651-999-6909",
            "fax_number": "651-297-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 OSBORNE RD NE",
            "address_2": "SUITE 240",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322765",
            "telephone_number": "763-783-8582",
            "fax_number": "763-783-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESHA",
        "first_name": "JYOTHI",
        "middle_name": "BHANU",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-03",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "42668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307127800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JYOTHI",
            "last_name": "BHANU",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.