Active NPI
Kim Daryl Fjelstad, DPM
- Podiatrist
- Burnsville, MN
National Provider Identifier
1992795504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 410
- Practice address
- 14000 Nicollet Ave
Suite 306
Burnsville, MN 55337-5790 - Phone
- (952) 435-2629
- Fax
- (952) 435-2650
- NPI assigned
- Oct 25, 2005
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 410 | MN | Primary |
Addresses
Primary practice location
14000 Nicollet Ave
Suite 306
Burnsville, MN 55337-5790
Mailing address
14000 Nicollet Ave
Suite 306
Burnsville, MN 55337-5790
Phone (952) 435-2629
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 913525100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 410 | MN | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roy R. Moeller D.P.M. P.a. | Past | Accepting new patients |
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.
-
- Foot & Ankle Surgery Podiatrist
- Chanhassen, MN
- NPI 1992985014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1992795504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14000 NICOLLET AVE",
"address_2": "SUITE 306",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375790",
"telephone_number": "952-435-2629",
"fax_number": "952-435-2650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14000 NICOLLET AVE",
"address_2": "SUITE 306",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375790",
"telephone_number": "952-435-2629",
"fax_number": "952-435-2650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FJELSTAD",
"first_name": "KIM",
"middle_name": "DARYL",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-25",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "MN",
"license": "410",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "913525100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.