Active NPI
Kyle John Anderson, MD
- Anesthesiology Physician
- Plymouth, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 76658
- Practice address
- 14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876 - Phone
- (763) 559-3779
- Fax
- (763) 450-3986
- NPI assigned
- Mar 31, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 76658 | MN | Primary |
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 practice location 1
12631 E 17th Ave
Aurora, CO 80045-2527
Phone (303) 724-1758
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- University of Iowa, RJ & L Carver College of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-5370
Hospital & facility affiliations
- Abbott Northwestern Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76658 | MN | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Anesthesia Network, LLP | Anesthesiology | Current | Accepting new patients |
Locations
4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Plymouth, MN
- NPI 1558314427
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1992333215",
"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"
},
{
"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": [
{
"address_1": "12631 E 17th Ave",
"address_purpose": "LOCATION",
"city": "Aurora",
"state": "CO",
"postal_code": "800452527",
"country_code": "US",
"telephone_number": "303-724-1758",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSON",
"first_name": "KYLE",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-31",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MN",
"license": "76658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.