NPIMap

Individual provider Active NPI

Kelly Johanna Dicke, APRN, CNP

  • Nurse Practitioner
  • Rochester, MN
National Provider Identifier
1629668462
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7905 Issued in MN
Practice address
2355 Hwy 36 W.
Ste. 100
Rochester, MN 55905-0001
Phone
(651) 292-2000
NPI assigned
Jan 26, 2021
Last updated
Jan 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7905 MN
Nurse Practitioner 363L00000X 7905 MN Primary

Addresses

Primary practice location

2355 Hwy 36 W.
Ste. 100
Rochester, MN 55905-0001

Mailing address

2355 Hwy 36 W.
Ste. 100
Rochester, MN 55905-0001
Phone (651) 292-2000

Other names 1

  • Kelly Johanna Huneke 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
I20210309000993 MN Practitioner - Nurse Practitioner 9638585169 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Radiology PAGroup PAC ID 4486568482, 217 clinicians

Practice addresses (Care Compare)

2355 Hwy 36 W
Suite 100
Roseville, MN 55113-3905
Phone (651) 292-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.17 of 100Reported as group
Quality
95
Improvement activities
40
Cost
82.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7905MNMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Suburban Imaging, LLC CurrentSince Oct 1, 2021 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Dec 17, 2023 Accepting new patients
Midwest Radiology Outpatient Imaging, LLC CurrentSince Oct 1, 2021 Accepting new patients
Allina Health System CurrentSince Dec 17, 2023 Accepting new patients
Midwest Radiology, PA CurrentSince Oct 1, 2021 Accepting new patients
Allina Health System CurrentSince Dec 17, 2023 Accepting new patients
Consulting Radiologists, LTD PastSince Oct 1, 2021 Accepting new patients
Courage Center Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

755 Crossroads Campus Dr NE
Ste 100
Buffalo, MN 55313
Phone (763) 684-6300

14000 Nicollet Ave
Ste 204
Burnsville, MN 55337
Phone (952) 898-2333

3960 Coon Rapids Blvd NW
Ste 200
Coon Rapids, MN 55433
Phone (763) 236-9236

5565 Blaine Ave
Ste 100
Inver Grove Heights, MN 55076
Phone (651) 241-9400

12000 Elm Creek Blvd N
Ste 310
Maple Grove, MN 55369
Phone (763) 416-7888

10705 Town Square Dr NE
Ste 100
Minneapolis, MN 55449
Phone (763) 236-5400

11850 Blackfoot St NW
Ste 180
Minneapolis, MN 55433
Phone (763) 795-1600

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

6545 France Ave S
Ste 115
Minneapolis, MN 55435
Phone (952) 893-1997

8990 Springbrook Dr NW
Ste 140
Minneapolis, MN 55433
Phone (763) 792-1900

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

1110 Yankee Doodle Rd
Saint Paul, MN 55121
Phone (651) 454-3970

14655 Galaxie Ave
Saint Paul, MN 55124
Phone (952) 432-4141

2355 Highway 36 W
Ste 100
Saint Paul, MN 55113
Phone (651) 292-0000

250 Thompson St
Saint Paul, MN 55102
Phone (651) 297-6504

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

7400 33rd St N
Ste 100
Saint Paul, MN 55128
Phone (651) 241-9240

4166 Lexington Ave N
Shoreview, MN 55126
Phone (651) 241-1306

4194 Lexington Ave N
Shoreview, MN 55126
Phone (651) 483-5461

150 Emerson Ave E
West St Paul, MN 55118
Phone (651) 241-1800

Organizations & group practices 10

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 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1629668462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HWY 36 W.",
            "address_2": "STE. 100",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HWY 36 W.",
            "address_2": "STE. 100",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKE",
        "first_name": "KELLY",
        "middle_name": "JOHANNA",
        "name_prefix": "Mrs.",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-26",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "7905",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "7905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HUNEKE",
            "middle_name": "JOHANNA",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.