Individual provider Active NPI

Kathryn E Decker, PA

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1558657064
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12780 Issued in MN
Practice address
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone
(612) 672-7422
NPI assigned
Jun 22, 2011
Last updated
Dec 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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 MA054902 PA
Physician Assistant 363A00000X 12780 MN Primary

Addresses

Primary practice location

909 Fulton St SE
Minneapolis, MN 55455-4800

Mailing address

909 Fulton St SE
Minneapolis, MN 55455-4800

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
I20180926000510 MN Practitioner - Physician Assistant 6901074590 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000

1700 University Ave W
Saint Paul, MN 55104-3727

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

6545 France Ave S
Suite 450
Edina, MN 55435-2122
Phone (952) 924-1520

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-6353

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12780MNMDPhysical Therapist
MA054902PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Physicians CurrentSince Oct 29, 2018 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Physicians CurrentSince Oct 29, 2018 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Feb 21, 2025 Accepting new patients
Healtheast Medical Research Institute CurrentSince Jan 2, 2025 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Oct 29, 2018 Accepting new patients
Fairview Health Services CurrentSince Oct 27, 2018 Accepting new patients
Fairview Health Services CurrentSince Oct 27, 2018 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

6545 France Ave S
Ste 450
Edina, MN 55435
Phone (612) 626-6688

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0331

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

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

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

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

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

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: kbard450988@fairview.direct-ci.com

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 3

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": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1558657064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-672-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "KATHRYN",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA054902",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.