KERRY PEDERSEN PA
NPI 1730587528
Physician Assistant in St Louis Park, MN

Q: What is Kerry Pedersen's NPI number?

The NPI number for Kerry Pedersen is 1730587528. It was assigned to this individual provider in the NPPES registry on December 11, 2014.

Q: What is Kerry Pedersen's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Kerry Pedersen was last updated on March 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since December 11, 2014PECOS EnrolledAccepts Medicare Assignment

3850 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416(952) 993-3025(952) 993-1937 Get Directions Write a Review

NPPES record last updated: March 10, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 10, 2021, Oct 27, 2016 (2 updates tracked since 2016).

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About Kerry Pedersen Pa NPPES

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

KERRY PEDERSEN PA (NPI 1730587528) is an individual physician assistant in St Louis Park, Minnesota, licensed in Minnesota (11795) and active in the NPI registry since December 2014. She is enrolled in Medicare PECOS, is affiliated with Park Nicollet Methodist Hospital, and is a graduate of Other (2014).

NPPES Registry Identity

NPI1730587528

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameKERRY PEDERSENCredential: PA

Location Address3850 PARK NICOLLET BLVDSt Louis Park, MN 55416-2527

Mailing Address8170 33rd Ave S # Ms 21110qBloomington, MN 55425-4516

Phone(952) 993-3025

Fax(952) 993-1937

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateDecember 11, 2014

Last NPPES UpdateMarch 10, 20212 updates tracked since enumeration

NPPES CertifiedMarch 10, 2021

✔ NPI 1730587528 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 · 11795

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.

3850 PARK NICOLLET BLVD, St Louis Park, MN 55416

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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

Kerry Pedersen Pa 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 ID7517288194

PECOS Enrollment IDI20150608002184

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

77 services75 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

75 services70 patients

Hospital Affiliations CMS Care Compare

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

Park Nicollet Methodist Hospital

Acute Care Hospitals · Saint Louis Park, MN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number240053

Location6500 Excelsior BlvdSaint Louis Park, MN 55426 · Hennepin County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55416 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.

ELISABETH JEAN MCCLEAN MD

Family Medicine