Active NPI
Sarah Kelley-Pegg, NP
- Primary Care Nurse Practitioner
- Minneapolis, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- 0589
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 337117000 | 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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| R1287246 | MN | MD | Nurse Practitioner |
| 0589 | MN | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Minnesota | Current | Accepting new patients | |
| Regents of the University of Minnesota | Current | Accepting new patients | |
| Regents of the University of Minnesota | Current | 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.
-
- Student Health Clinic/Center
- Minneapolis, MN
- NPI 1013137355
-
- Federally Qualified Health Center (FQHC)
- Minneapolis, MN
- NPI 1114019858
-
- Clinic Pharmacy
- Minneapolis, MN
- NPI 1528288875
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2025; 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.