NPIMap

Individual provider Active NPI

Jenelle Philipczyk Kelley, PA-C

  • Medical Physician Assistant
  • Edina, MN
National Provider Identifier
1619272572
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1525 Issued in MN
Practice address
6363 France Ave S
Suite 212
Edina, MN 55435-2129
Phone
(651) 312-1700
Fax
(952) 920-4148
NPI assigned
Jan 24, 2011
Last updated
Nov 2, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1525 MN Primary

Addresses

Primary practice location

6363 France Ave S
Suite 212
Edina, MN 55435-2129

Mailing address

1055 Westgate Dr
Suite 190
Saint Paul, MN 55114-1065
Phone (651) 312-1505

Other names 1

  • Jenelle Marie Philipczyk 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
I20110406000817 MN Practitioner - Physician Assistant 8820272487 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

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

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1525MNMDGenetic Counselor (M.S.)
10885MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Jul 30, 2016 Accepting new patients
Fairview Express Care CurrentSince Nov 4, 2020 Accepting new patients
Fairview Health Services CurrentSince Jul 30, 2016 Accepting new patients
Fairview Express Care CurrentSince Nov 4, 2020 Accepting new patients
Colon & Rectal Surgery Associates LTD PastSince May 16, 1991 Accepting new patients
Pelvic Floor Center, LLC Past Accepting new patients

Locations

400 Stinson Blvd
Minneapolis, MN 55413
Phone (612) 672-2258

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

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

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

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

909 Fulton St SE
Ste 202
Minneapolis, MN 55455
Phone (612) 273-8383

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

Interoperability endpoints

  • Direct secure messaging: jkelley209196@fairview.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1619272572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 WESTGATE DR",
            "address_2": "SUITE 190",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141065",
            "telephone_number": "651-312-1505",
            "fax_number": "651-641-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 212",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "651-312-1700",
            "fax_number": "952-920-4148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "JENELLE",
        "middle_name": "PHILIPCZYK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "1525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENELLE",
            "last_name": "PHILIPCZYK",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.