NPIMap

Individual provider Active NPI

Kristen Emily Lewicki, NP-C

  • Nurse Practitioner
  • Blaine, MN
National Provider Identifier
1760730980
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3273 Issued in MN
Practice address
10705 Town Square Dr NE
Blaine, MN 55449-8184
Phone
(763) 236-5400
NPI assigned
Aug 20, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F0712464 MN
Nurse Practitioner 363L00000X 3273 MN Primary

Addresses

Primary practice location

10705 Town Square Dr NE
Blaine, MN 55449-8184

Mailing address

2027 141St Ave NE
Ham Lake, MN 55304-6551
Phone (651) 338-4027

Other names 1

  • Kristen Emily Berry Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address klewicki57188@excellian.direct.allina.com Direct

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
I20121102000406 MN Practitioner - Nurse Practitioner 5193976900 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

  • Allina Health Home Health Home health agency, Minneapolis, MN, CCN 248091
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • Mercy Hospital Hospital, Coon Rapids, MN, CCN 240115

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3273MNMDNurse Practitioner
F0712464MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Nov 17, 2014 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Nov 17, 2014 Accepting new patients
Allina Health System Past Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

10705 Town Square Dr NE
Ste 100
Minneapolis, MN 55449
Phone (763) 236-5400

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

Interoperability endpoints

  • Direct secure messaging: klewicki57188@excellian.direct.allina.com

Organizations & group practices 6

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 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1760730980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2027 141ST AVE NE",
            "city": "HAM LAKE",
            "state": "MN",
            "postal_code": "553046551",
            "telephone_number": "651-338-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10705 TOWN SQUARE DR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554498184",
            "telephone_number": "763-236-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWICKI",
        "first_name": "KRISTEN",
        "middle_name": "EMILY",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-20",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "F0712464",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "3273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klewicki57188@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "10705 Town Square Dr NE",
            "city": "Blaine",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554498184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "BERRY",
            "middle_name": "EMILY",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.