Individual provider Active NPI

Sarah Kelley-Pegg, NP

  • Primary Care Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1780883256
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
0589 Issued in MN
Practice address
410 Church St SE
Minneapolis, MN 55455-0222
Phone
(612) 625-8400
Fax
(612) 667-3211
NPI assigned
Jul 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R1287246 MN
Primary Care Nurse Practitioner 363LP2300X 0589 MN Primary

Addresses

Primary practice location

410 Church St SE
Minneapolis, MN 55455-0222

Mailing address

410 Church St SE
Minneapolis, MN 55455-0222
Phone (612) 625-8400

Other practice location 1

1501 Hennepin Ave
Minneapolis, MN 55403-1710
Phone (612) 625-8400

Other identifiers 1

IdentifierTypeStateIssuer
337117000MedicaidMN

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
I20070827000298 MN Practitioner - Nurse Practitioner 5799877494

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

410 Church St SE
Minneapolis, MN 55455-0222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R1287246MNMDNurse Practitioner
0589MNMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Minnesota Current Accepting new patients
Regents of the University of Minnesota CurrentSince Nov 10, 2008 Accepting new patients
Regents of the University of Minnesota CurrentSince Nov 10, 2008 Accepting new patients

Locations

1501 Hennepin Ave
Minneapolis, MN 55403
Phone (612) 625-8400

410 Church St SE
Minneapolis, MN 55455
Phone (612) 625-8400

410 Church St SE
#W235
Minneapolis, MN 55455

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1780883256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CHURCH ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550222",
            "telephone_number": "612-625-8400",
            "fax_number": "612-677-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CHURCH ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550222",
            "telephone_number": "612-625-8400",
            "fax_number": "612-667-3211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Hennepin Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554031710",
            "country_code": "US",
            "telephone_number": "612-625-8400",
            "fax_number": "612-677-3211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY-PEGG",
        "first_name": "SARAH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-16",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R1287246",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MN",
            "license": "0589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337117000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.