Jessica Taylor Koehnen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14456 Issued in MN

Practice address

1440 Marshall St NE
Minneapolis, MN 55413-1040

Phone

(920) 205-9396

NPI assigned

Feb 9, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sasaki Medical LLCGroup PAC ID 3779879903, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Sasaki Medical LLC

  dba Kai Shin Clinic

  • Addiction Medicine (Family Medicine) Physician
  • Roseville, MN
  • NPI 1326490475
  Medicare reassignment Care Compare group NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MN

  Medicare reassignment
• Sasaki Medical LLC

  dba Kai Shin Reference Lab

  • Clinical Medical Laboratory
  • Saint Paul, MN
  • NPI 1992472757
  NPD
• Sasaki Medical LLC

  dba Kai Shin Clinic

  • Addiction Medicine (Family Medicine) Physician
  • Saint Paul, MN
  • NPI 1043829625
  NPD (past)

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1710631619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 MARSHALL ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 MARSHALL ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131040",
            "telephone_number": "920-205-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEHNEN",
        "first_name": "JESSICA",
        "middle_name": "TAYLOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-09",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jkoehnen1@css.edu",
            "affiliation": "N",
            "address_1": "1440 Marshall St NE",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554131040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Halima Ahmed Kodah
• Kent Kodalen, PH.D.
• Molly Kodl, PHD
• Jennifer Koehn, MSW
• Kate Zelic Koehn, PHD
• Kelly K Koehnen, D.D.S.
• Robert Joseph Koelbl, RPH
• Timothy J Koelz, M.D.
• Renee Diane Koemptgen, CNS
• Kenneth S Koeneman, MD

• Physician Assistant in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.