NPIMap

Individual provider Active NPI

Kimberly K Jacobsen, MD

  • Anesthesiology Physician
  • Plymouth, MN
National Provider Identifier
1851786248
Registry record updated Nov 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
78154 Issued in MN
Practice address
14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876
Phone
(763) 559-3779
Fax
(763) 450-3986
NPI assigned
Apr 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 66773 WI
Anesthesiology Physician 207L00000X 78154 MN Primary
Anesthesiology Physician 207L00000X 66773 WI

Addresses

Primary practice location

14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876

Mailing address

PO Box 47159
Plymouth, MN 55447-0159
Phone (763) 559-3779

Other identifiers 1

IdentifierTypeStateIssuer
1851786248MedicaidWI

Other names 1

  • Kimberly K Phillips Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200717003126 WI Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists)Practitioner - Neurology 0042634479 Reassigns benefits to 1 organization
I20241126002149 MN Practitioner - Anesthesiology 0042634479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Creighton University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metropolitan Anesthesia Network LLPGroup PAC ID 5698689123, 516 clinicians

Practice addresses (Care Compare)

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.99 of 100Reported as group
Quality
82.81
Promoting interoperability
100
Improvement activities
40
Cost
77.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66773WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Network, LLP Anesthesiology CurrentSince Dec 1, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. Anesthesiology CurrentSince Jul 1, 2020 Accepting new patients

Locations

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Organizations & group practices 2

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731196800000",
    "number": "1851786248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47159",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554470159",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N STE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474876",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "KIMBERLY",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "WI",
            "license": "66773",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "78154",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "66773",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851786248",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "PHILLIPS",
            "middle_name": "K",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.