NPIMap

Individual provider Active NPI

Kelly L Dziedzic, PA-C

  • Physician Assistant
  • Burnsville, MN
National Provider Identifier
1568437879
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9792 Issued in MN
Practice address
1000 W 140TH St Unit 201
Burnsville, MN 55337-4833
Phone
(952) 808-3000
Fax
(952) 808-3001
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9792 MN Primary

Addresses

Primary practice location

1000 W 140TH St Unit 201
Burnsville, MN 55337-4833

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5042

Other practice location 1

2090 Woodwinds Dr
Woodbury, MN 55125-2522
Phone (651) 968-5801

Other identifiers 1

IdentifierTypeStateIssuer
205559700MedicaidMN

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
I20031114000298 MN Practitioner - Physician Assistant 4486568433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1000 W 140TH St Unit
Suite 201
Burnsville, MN 55337-4833

Hospital & facility affiliations

  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
  • M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Insititue CurrentSince Jul 21, 2018 Accepting new patients
Healtheast Medical Research Institute CurrentSince Jul 21, 2018 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Dec 31, 2018 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Dec 31, 2018 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212

1000 W 140th St
Unit 201
Burnsville, MN 55337
Phone (952) 808-3000

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

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

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

4695 Shoreline Dr
Spring Park, MN 55384
Phone (952) 442-7890

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

Organizations & group practices 6

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 5

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1568437879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925",
            "telephone_number": "651-968-5042",
            "fax_number": "651-968-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W 140TH ST UNIT 201",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374833",
            "telephone_number": "952-808-3000",
            "fax_number": "952-808-3001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2090 Woodwinds Dr",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551252522",
            "country_code": "US",
            "telephone_number": "651-968-5801",
            "fax_number": "651-968-5899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DZIEDZIC",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205559700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.