Active NPI
Kristina Kelly Shaffer, M.D.
- Dermatology Physician
- Eagan, MN
National Provider Identifier
1730298910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 43145
- Practice address
- 1215 Town Centre Dr
Suite 200
Eagan, MN 55123-1033 - Phone
- (651) 251-3300
- Fax
- (651) 255-3450
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 43145 | MN | Primary |
Addresses
Primary practice location
1215 Town Centre Dr
Suite 200
Eagan, MN 55123-1033
Mailing address
60 Plato Blvd E
Suite 270
Saint Paul, MN 55107-1827
Phone (651) 209-1600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 190170200 | Medicaid | MN |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Columbia University College of Physicians and Surgeons, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1215 Town Centre Dr
Suite 200
Eagan, MN 55123-1033
Phone (651) 251-3300
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 79.99 of 100
- Quality
- 61.48
- Promoting interoperability
- 93
- Improvement activities
- 40
- Cost
- 77.67
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 600 |
| Removal or shaving of skin growth | 33 |
| Skin biopsy | 157 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43145 | MN | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology Consultants, PA | Dermatology | Current | Accepting new patients |
Locations
1215 Town Centre Dr
Ste 200
Eagan, MN 55123
Phone (651) 251-3300
60 Plato Blvd E
Ste 270
Saint Paul, MN 55107
Phone (651) 209-1600
3555 Willow Lake Blvd
Ste 240
Vadnais Heights, MN 55110
Phone (651) 770-0110
576 Bielenberg Dr
Ste 200
Woodbury, MN 55125
Phone (651) 209-1600
Interoperability endpoints
- kshaffer@dermcons.encitedirect.com
Organizations & group practices 1
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.
-
- Dermatology Physician
- Woodbury, MN
- NPI 1568567139
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359331200000",
"number": "1730298910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 PLATO BLVD E",
"address_2": "SUITE 270",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551071827",
"telephone_number": "651-209-1600",
"fax_number": "651-291-9169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 TOWN CENTRE DR",
"address_2": "SUITE 200",
"city": "EAGAN",
"state": "MN",
"postal_code": "551231033",
"telephone_number": "651-251-3300",
"fax_number": "651-255-3450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "KRISTINA",
"middle_name": "KELLY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2013-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MN",
"license": "43145",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "190170200",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; 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.