Brayton Kiedrowski, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

77987 Issued in MN

Practice address

1700 Saint Francis Ave
Shakopee, MN 55379

Phone

(952) 831-8742

NPI assigned

May 11, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Sports MedicineAlso: Family Practice

Education

Midwestern University, Chicago College of Osteopathic Med, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Reid Physician Associates IncGroup PAC ID 6406910769, 427 clinicians

Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Francis Regional Medical Center Hospital, Shakopee, MN, CCN 240104
• Reid Health Hospital, Richmond, IN, CCN 150048
• Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bkiedrowski461498@reidhealth.direct-ci.com

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.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Tria Orthopaedic Center LLC

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1518273085

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Reid Physician Associates, Inc.

  • Internal Medicine Physician
  • Richmond, IN
  • NPI 1265689111

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593

  Multi-Specialty

  NPD
• Reid Physician Associates, Inc

  • Radiology Clinic/Center
  • Winchester, IN
  • NPI 1417653221
  NPD

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

• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • Maple Grove, MN
  • NPI 1174980692
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1194113217
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1245615772
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • Mental Illness Community Based Residential Treatment Facility
  • St Louis Park, MN
  • NPI 1578717336

  Hospital

  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1649220724
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1942585286
  Care Compare affiliation
• St Francis Regional Medical Center

  • General Acute Care Hospital
  • Shakopee, MN
  • NPI 1578520045
  Care Compare affiliation
• Reid Hospital & Health Care Services, Inc

  • General Acute Care Hospital
  • Richmond, IN
  • NPI 1063457380
  Care Compare affiliation

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1770019796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 SAINT FRANCIS AVE",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "55379",
            "telephone_number": "952-831-8742"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Highland Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "IN",
            "postal_code": "473748810",
            "country_code": "US",
            "telephone_number": "765-962-4444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIEDROWSKI",
        "first_name": "BRAYTON",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "88752",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IN",
            "license": "02006537A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "77987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bkiedrowski461498@ReidHealth.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Reid Physician Associates, Inc.",
            "address_1": "1400 Highland Rd Ste 1",
            "city": "Richmond",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473748810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Maureen Kennedy Laliberte, PA-C
• Lara Rae Kennedy, PHARMD
• Jacquelyn Lee Kerkow-Dohmen, LICSW
• Daniel N Kessler, PSY.D.
• Mohamed Hassan Khattab, M.D.
• Alexi Elizabeth Kimm
• Everlyne Kemunto Kimori
• Donaldson Wright Kingsley III, M.D.
• Kyle E Kingsley, MD
• Richard Te Kiok, M.D.

• Sports Medicine (Family Medicine) Physician in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Sports Medicine (Family Medicine) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.