NPIMap

Individual provider Active NPI

Kelli Jean Penrose, P.A., ATC

  • Physician Assistant
  • Sartell, MN
National Provider Identifier
1740435551
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1901 Connecticut Ave S
Sartell, MN 56377-2554
Phone
(320) 259-4100
Fax
(320) 259-8044
NPI assigned
Nov 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X MN
Physician Assistant 363A00000X MN Primary

Addresses

Primary practice location

1901 Connecticut Ave S
Sartell, MN 56377-2554

Mailing address

1901 Connecticut Ave S
Sartell, MN 56377-2554
Phone (320) 259-4100

Other practice location 1

3315 Roosevelt Rd Ste 200B
Saint Cloud, MN 56301-9687
Phone (320) 259-4100

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
I20090420000322 MN Practitioner - Physician Assistant 5395892806 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Cloud Orthopedic Associates LTDGroup PAC ID 0143113951, 44 clinicians

Practice addresses (Care Compare)

1901 Connecticut Ave S
Sartell, MN 56377-2554
Phone (320) 259-4100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.31 of 100Reported as group
Quality
74.55
Promoting interoperability
79
Improvement activities
40
Cost
83.98

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Astera Health CurrentSince Aug 20, 2023 Accepting new patients
County of Meeker CurrentSince Nov 1, 2024 Accepting new patients
County of Meeker CurrentSince Nov 1, 2024 Accepting new patients
Astera Health CurrentSince Aug 20, 2023 Accepting new patients
Welia Health Current Accepting new patients

Locations

612 S Sibley Ave
Litchfield, MN 55355
Phone (320) 693-3242

301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317

3315 Roosevelt Rd
Ste 200B
Saint Cloud, MN 56301
Phone (320) 259-4100

1901 Connecticut Ave S
Sartell, MN 56377
Phone (320) 259-4100

415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510

421 11th St NW
Wadena, MN 56482
Phone (218) 631-3510

Interoperability endpoints

  • Direct secure messaging: kpenrose@stcloudortho1831.srs-direct.com
  • Direct secure messaging: kpenrose1037@direct.centracare.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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1227139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1740435551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772554",
            "telephone_number": "320-259-4100",
            "fax_number": "320-259-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772554",
            "telephone_number": "320-259-4100",
            "fax_number": "320-259-8044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3315 Roosevelt Rd Ste 200B",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563019687",
            "country_code": "US",
            "telephone_number": "320-259-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENROSE",
        "first_name": "KELLI",
        "middle_name": "JEAN",
        "credential": "P.A., ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-20",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.