MRS. KRISTIN BUCKNER JAKUBOWSKI
NPI 1578852315
Pediatrics in Minnetonka, MN
About Mrs. Kristin Buckner Jakubowski NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. KRISTIN BUCKNER JAKUBOWSKI (NPI 1578852315) is an individual pediatrics provider in Minnetonka, Minnesota, licensed in Minnesota (59155) and active in the NPI registry since April 2011. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mrs. Kristin Buckner Jakubowski is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kristin Jakubowski reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Minnetonka, MN 55345
- Reassigned Medicare billing, Minnesota enrollment
- Medicare enrollment name: South Lake Clinic PA
- 28 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 55345 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 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MINNETONKA, MN 55345
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 Kristin Jakubowski's NPI number?
The NPI number for Kristin Jakubowski is 1578852315. It was assigned to this individual provider in the NPPES registry on April 1, 2011. The provider is also known as Miss Kristin Fisher Buckner.
Where is Kristin Jakubowski located?
Kristin Jakubowski practices at 17705 Hutchins Dr Ste 250, Minnetonka, MN 55345. The listed phone number is (952) 401-8300.
What is Kristin Jakubowski's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Kristin Jakubowski enrolled in Medicare?
Yes. Kristin Jakubowski is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kristin Jakubowski's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kristin Jakubowski reassigns Medicare benefits to South Lake Clinic, P.A. (Minnetonka, 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 Kristin Jakubowski's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kristin Jakubowski accept?
Health plans from HealthPartners list Kristin Jakubowski as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kristin Jakubowski was last updated on January 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mrs. Kristin Buckner Jakubowski · NPI 1578852315
Pediatrics physician in Minnetonka, Minnesota. Individual provider, active in the CMS NPPES registry since April 1, 2011.
## Identity
- **NPI:** 1578852315 (Entity type: Individual)
- **Enumerated:** April 1, 2011
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 59155 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 17705 HUTCHINS DR STE 250, Minnetonka, MN 55345-4103
- **Phone:** (952) 401-8300 · **Fax:** (952) 401-8242
## 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:** South Lake Clinic, P.A. (NPI 1427027184, Minnetonka, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 6, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1578852315) · Data from the CMS NPPES public registry.