Individual provider Active NPI

Patricia Riess Kubicka, MD

  • Pediatrics Physician
  • Elk River, MN
National Provider Identifier
1588601231
Registry record updated Jun 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
47524 Issued in MN
Practice address
290 Main St NW
Elk River, MN 55330-1270
Phone
(763) 241-5800
NPI assigned
Jun 1, 2006
Last updated
Jun 4, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 47524 MN Primary

Addresses

Primary practice location

290 Main St NW
Elk River, MN 55330-1270

Mailing address

290 Main St NW
Elk River, MN 55330-1270

Other names 1

  • Patricia Lynn Riess Other 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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050525000461 MN Practitioner - Pediatric Medicine 0446292965 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47524MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Oct 1, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Jun 9, 2010 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Oct 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 31, 2020 Accepting new patients
Fairview Health Services CurrentSince Jun 9, 2010 Accepting new patients
Fairview Express Care CurrentSince Oct 31, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

290 Main St NW
Elk River, MN 55330
Phone (763) 241-5800

290 Main St NW
Ste 100
Elk River, MN 55330
Phone (763) 241-0373

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

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

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

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

Interoperability endpoints

  • Direct secure messaging: pkubicka39366@fairview.direct-ci.com

Organizations & group practices 12

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275609600000",
    "number": "1588601231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301270",
            "telephone_number": "763-241-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBICKA",
        "first_name": "PATRICIA",
        "middle_name": "RIESS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2010-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "47524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "RIESS",
            "middle_name": "LYNN",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Elk River, MN

Sources for this page

Verify at the official NPI Registry.