MR. JACOB ANDREW KINGSTON RN
NPI 1366019796
Nurse Anesthetist, Certified Registered in Plymouth, MN
About Mr. Jacob Andrew Kingston Rn NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. JACOB ANDREW KINGSTON RN (NPI 1366019796) is an individual nurse anesthetist, certified registered in Plymouth, Minnesota, licensed in Minnesota (2630) and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS, is affiliated with M Health Fairview Southdale Hospital, and is a graduate of Other (2021).
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 and accepts Medicare assignment
Mr. Jacob Andrew Kingston Rn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
12Medicare enrollment records show Jacob Kingston reassigns Medicare billing to 12 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Plymouth, MN 55447
- Reassigned Medicare billing, Minnesota enrollment
- 1,033 clinicians in this Medicare group
Plymouth, MN 55441
- Reassigned Medicare billing, Minnesota enrollment
- 2,609 clinicians in this Medicare group
Maple Grove, MN 55369
- Reassigned Medicare billing, Minnesota enrollment
- 226 clinicians in this Medicare group
Minneapolis, MN 55487
- Reassigned Medicare billing, Minnesota enrollment
- 1,247 clinicians in this Medicare group
Edina, MN 55435
- Reassigned Medicare billing, Minnesota enrollment
- 4,038 clinicians in this Medicare group
Edina, MN 55435
- Reassigned Medicare billing, Minnesota enrollment
- 118 clinicians in this Medicare group
Minneapolis, MN 55454
- Reassigned Medicare billing, Minnesota enrollment
- 681 clinicians in this Medicare group
Minneapolis, MN 55431
- Reassigned Medicare billing, Minnesota enrollment
- 50 clinicians in this Medicare group
Saint Paul, MN 55104
- Reassigned Medicare billing, Minnesota enrollment
- 1,178 clinicians in this Medicare group
Blaine, MN 55449
- Reassigned Medicare billing, Minnesota enrollment
- 29 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.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
M Health Fairview Southdale Hospital
Acute Care Hospitals · Edina, MNM Health Fairview St John's Hospital
Acute Care Hospitals · Maplewood, MNPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55447 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.
PLYMOUTH, MN 55447
PLYMOUTH, MN 55447
PLYMOUTH, MN 55447
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 Jacob Kingston's NPI number?
The NPI number for Jacob Kingston is 1366019796. It was assigned to this individual provider in the NPPES registry on June 4, 2021.
Where is Jacob Kingston located?
Jacob Kingston practices at 14700 28th Ave N Ste 20, Plymouth, MN 55447. The listed phone number is (763) 559-3779.
What is Jacob Kingston's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Jacob Kingston enrolled in Medicare?
Yes. Jacob Kingston is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Jacob Kingston's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Kingston reassigns Medicare benefits to 12 organizations: Metropolitan Anesthesia Network, LLP (Plymouth, MN), Allina Health System (Plymouth, MN), Fairview Maple Grove Surgery Center, LLC (Maple Grove, MN), Hennepin Healthcare System, Inc (Minneapolis, MN), Fairview Health Services (Edina, MN) and 7 more organizations, listed in the Medicare section above. Each 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 Jacob Kingston's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Jacob Kingston affiliated with any hospitals?
According to CMS data, Jacob Kingston is affiliated with M Health Fairview Southdale Hospital and M Health Fairview St John's Hospital.
When was this NPI record last updated?
The NPPES record for Jacob Kingston was last updated on May 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.
# Mr. Jacob Andrew Kingston, RN · NPI 1366019796
Nurse Anesthetist, Certified Registered physician in Plymouth, Minnesota. Individual provider, active in the CMS NPPES registry since June 4, 2021.
## Identity
- **NPI:** 1366019796 (Entity type: Individual)
- **Enumerated:** June 4, 2021
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 2630 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 14700 28TH AVE N STE 20, Plymouth, MN 55447-4876
- **Phone:** (763) 559-3779
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging
- **Bills Medicare through:** 12 organizations under Medicare reassignment (form CMS-855R): Metropolitan Anesthesia Network, LLP (NPI 1558314427, Plymouth, MN); Allina Health System (NPI 1861363756, Plymouth, MN); Fairview Maple Grove Surgery Center, LLC (NPI 1730068032, Maple Grove, MN); Hennepin Healthcare System, Inc (NPI 1528361573, Minneapolis, MN); Fairview Health Services (NPI 1699752915, Edina, MN); and 7 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** May 30, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1366019796) · Data from the CMS NPPES public registry.