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KELLY WITUCKI PA-C
NPI 1649150822
Physician Assistant in Maplewood, MN

Active since September 06, 2025PECOS EnrolledAccepts Medicare Assignment
1575 BEAM AVE, MAPLEWOOD, MN 55109(651) 232-7348 Get Directions Write a Review

NPPES record last updated: January 22, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 22, 2026, Sep 6, 2025 (2 updates tracked since 2025).

About Kelly Witucki Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY WITUCKI PA-C (NPI 1649150822) is an individual physician assistant in Maplewood, Minnesota, licensed in Minnesota (15652) and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS, is affiliated with M Health Fairview St John's Hospital, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1649150822
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKELLY WITUCKICredential: PA-C
Location Address1575 BEAM AVEMaplewood, MN 55109-1126
Mailing Address2829 University Ave Se Ste 730Minneapolis, MN 55414-3279
Phone(651) 232-7348
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateSeptember 6, 2025
Last NPPES UpdateJanuary 22, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 22, 2026
✔ NPI 1649150822 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in MN · 15652
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1575 BEAM AVE, Maplewood, MN 55109
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Witucki Pa-c 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.

PECOS PAC ID5597240499
PECOS Enrollment IDI20260330000564
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

M Health Fairview St John's Hospital

Acute Care Hospitals · Maplewood, MN
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240210
Location1575 Beam AvenueMaplewood, MN 55109 · Ramsey County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55109 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

BRIAN TOLLY M.D.
Anesthesiology
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (920) 915-9034
YONG YANG
Interpreter
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (651) 232-6177
GRETCHEN L HANSON CNNP
Nurse Practitioner (Neonatal)
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (651) 232-7000
DR. NATHAN DEAN SWENSON M.D.
Emergency Medicine
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (651) 232-7348
NICHOLAS BASIL LOUDAS
Radiology (Radiation Oncology)
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (651) 232-7970
HTOO BWAY INTERPRETER
Interpreter
1575 BEAM AVE
SAINT PAUL, MN 55109
Ramsey County (651) 232-2917
HEALTHEAST ST. JOHN'S HOSPITAL
Pharmacy (Institutional Pharmacy)
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (651) 232-7970
DR. RAHUL KORANNE MD
Hospitalist
1575 BEAM AVE
MAPLEWOOD, MN 55109
Ramsey County (651) 232-7800

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 Witucki's NPI number?

The NPI number for Kelly Witucki is 1649150822. It was assigned to this individual provider in the NPPES registry on September 6, 2025.

Where is Kelly Witucki located?

Kelly Witucki practices at 1575 Beam Ave, Maplewood, MN 55109. The listed phone number is (651) 232-7348.

What is Kelly Witucki's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kelly Witucki enrolled in Medicare?

Yes. Kelly Witucki 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.

Is Kelly Witucki affiliated with any hospitals?

According to CMS data, Kelly Witucki is affiliated with M Health Fairview St John's Hospital.

When was this NPI record last updated?

The NPPES record for Kelly Witucki was last updated on January 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.