Individual provider Active NPI

Kelsey Reineke

  • Physician Assistant
  • Woodbury, MN
National Provider Identifier
1710655923
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1825 Woodwinds Dr
Woodbury, MN 55125-2202
Phone
(320) 287-0528
NPI assigned
Sep 1, 2021
Last updated
Oct 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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 Primary

Addresses

Primary practice location

1825 Woodwinds Dr
Woodbury, MN 55125-2202

Mailing address

1825 Woodwinds Dr
Woodbury, MN 55125-2202
Phone (651) 326-1044

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240105001198 MN Practitioner - Physician Assistant 5193176980 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Specialty ServicesGroup PAC ID 3072083286, 303 clinicians

Practice addresses (Care Compare)

1099 Helmo Ave N
Suite 100
Oakdale, MN 55128-6034
Phone (651) 326-5300

1655 Beam Ave
Suite 111
Maplewood, MN 55109-1475
Phone (651) 471-2233

1700 University Ave W
Saint Paul, MN 55104-3727

6401 University Ave NE
FL 1
Fridley, MN 55432-4341
Phone (612) 626-5775

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute CurrentSince Oct 16, 2023 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Oct 16, 2023 Accepting new patients
Fairview Express Care CurrentSince Oct 16, 2023 Accepting new patients
Fairview Express Care CurrentSince Oct 16, 2023 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

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

1099 Helmo Ave N
Ste 100
Saint Paul, MN 55128
Phone (651) 326-5300

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

1825 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

1875 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Interoperability endpoints

  • Direct secure messaging: kreineke599940@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.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1710655923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 WOODWINDS DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252202",
            "telephone_number": "651-326-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 WOODWINDS DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252202",
            "telephone_number": "320-287-0528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REINEKE",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.