KELLY GLYNN CPNP
NPI 1104550680
Nurse Practitioner - Pediatrics in Minneapolis, MN
About Kelly Glynn Cpnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY GLYNN CPNP (NPI 1104550680) is an individual pediatrics provider in Minneapolis, Minnesota, licensed in Minnesota (9300) and active in the NPI registry since July 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Glynn Cpnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Glynn reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Minneapolis, MN 55404
- Reassigned Medicare billing, Minnesota enrollment
- 20 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55404 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MINNEAPOLIS, MN 55404
MINNEAPOLIS, MN 55404
MINNEAPOLIS, MN 55404
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Glynn's NPI number?
The NPI number for Kelly Glynn is 1104550680. It was assigned to this individual provider in the NPPES registry on July 12, 2022.
Where is Kelly Glynn located?
Kelly Glynn practices at 2530 Chicago Ave, Minneapolis, MN 55404. The listed phone number is (612) 813-8000.
What is Kelly Glynn's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Kelly Glynn enrolled in Medicare?
Yes. Kelly Glynn is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Glynn's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Glynn reassigns Medicare benefits to Pediatric Surgical Associates Ltd (Minneapolis, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Glynn's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Glynn was last updated on February 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Glynn, CPNP · NPI 1104550680
Pediatrics physician in Minneapolis, Minnesota. Individual provider, active in the CMS NPPES registry since July 12, 2022.
## Identity
- **NPI:** 1104550680 (Entity type: Individual)
- **Enumerated:** July 12, 2022
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 9300 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 2530 CHICAGO AVE, Minneapolis, MN 55404-4289
- **Phone:** (612) 813-8000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Pediatric Surgical Associates Ltd (NPI 1093778292, Minneapolis, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 25, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1104550680) · Data from the CMS NPPES public registry.