NPIMap

Individual provider Active NPI

Brittany Rae Kelly, PA-C

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1649640152
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11954 Issued in MN
Practice address
401 Phalen Blvd
Saint Paul, MN 55130
Phone
(952) 967-7977
Fax
(651) 254-8558
NPI assigned
Sep 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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 11954 MN Primary

Addresses

Primary practice location

401 Phalen Blvd
Saint Paul, MN 55130

Mailing address

8170 33Rd Ave
Ms 21110Q
Bloomington, MN 55425-4516
Phone (952) 967-7977

Other practice location 1

2211 Park Ave
Minneapolis, MN 55404-3711
Phone (612) 871-1144

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
I20151015002237 MN Practitioner - Physician Assistant 8921317850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

15350 English Ave
Apple Valley, MN 55124-6252
Phone (952) 431-8500

233 Radio Dr
Woodbury, MN 55125-5805
Phone (952) 967-7616

2500 Como Ave
Saint Paul, MN 55108-1460
Phone (651) 641-0020

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2343MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Dec 10, 2018 Accepting new patients
Group Health, Inc. CurrentSince Dec 10, 2018 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

401 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-7870

233 Radio Dr
Woodbury, MN 55125
Phone (651) 254-7400

Interoperability endpoints

  • Direct secure messaging: bkelly116888@direct.healthpartners.com

Organizations & group practices 2

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 8

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": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1649640152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-967-7977",
            "fax_number": "651-254-8558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PHALEN BLVD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55130",
            "telephone_number": "952-967-7977",
            "fax_number": "651-254-8558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2211 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554043711",
            "country_code": "US",
            "telephone_number": "612-871-1144",
            "fax_number": "612-871-2012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "BRITTANY",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.