Individual provider Active NPI

Kendall Dewayne Ricklefs, D.O.

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1780887547
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
48744 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-2563
NPI assigned
Jun 8, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 48744 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

815 13TH Ave SE
#216
Minneapolis, MN 55414-1471

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070917000254 MN Practitioner - Internal Medicine 1153415575 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians

Practice addresses (Care Compare)

1700 University Ave W
Saint Paul, MN 55104-3727

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-1313

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

  • M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207

Merit-based Incentive Payment System (MIPS)

Final score
96.44 of 100Reported as group
Quality
82.65
Promoting interoperability
100
Improvement activities
40
Cost
77.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
48744MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Jan 6, 2023 Accepting new patients
Fairview Clinics CurrentSince Aug 31, 2007 Accepting new patients
Fairview Health Services CurrentSince Aug 31, 2007 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Jan 6, 2023 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1825 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: kricklefs67292@fairview.direct-ci.com

Organizations & group practices 8

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 2

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": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780887547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 13TH AVE SE",
            "address_2": "#216",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKLEFS",
        "first_name": "KENDALL",
        "middle_name": "DEWAYNE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "48744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.