BODHI KIKUE KANNON M.D.
NPI 1740306240
Psychiatry & Neurology - Psychiatry in Fridley, MN

Q: What is Bodhi Kannon's NPI number?

The NPI number for Bodhi Kannon is 1740306240. It was assigned to this individual provider in the NPPES registry on March 22, 2007. The provider is also known as Judith Kikue Centerwall M.D..

Q: What is Bodhi Kannon's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Bodhi Kannon was last updated on March 30, 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 March 22, 2007PECOS EnrolledAccepts Medicare Assignment

83.53/100

CMS Quality Rating

480 OSBORNE RD NE STE 260, FRIDLEY, MN 55432(763) 236-3800 Get Directions Write a Review

NPPES record last updated: March 30, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Bodhi Kikue Kannon M.d. NPPES

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

BODHI KIKUE KANNON M.D. (NPI 1740306240) is an individual psychiatry provider in Fridley, Minnesota, licensed in Minnesota (61296) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS and is a graduate of University Of Washington School Of Medicine (1989).

NPPES Registry Identity

NPI1740306240

Entity TypeIndividualFemale

Primary Taxonomy2084P0800X

Provider Legal NameBODHI KIKUE KANNONCredential: M.D.

Location Address480 OSBORNE RD NE STE 260Fridley, MN 55432-2866

Mailing Address2925 Chicago AveMinneapolis, MN 55407-1321 · (612) 262-9000

Phone(763) 236-3800

Sole ProprietorNo

Medical School CMSUniversity Of Washington School Of MedicineGraduated 1989

Enumeration DateMarch 22, 2007

Last NPPES UpdateMarch 30, 2021

NPPES CertifiedMarch 30, 2021

✔ NPI 1740306240 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

Licenses✔ Licensed in MN · 61296✔ Licensed in WA · MD00031094

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

480 OSBORNE RD NE STE 260, Fridley, MN 55432

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Other Names 1

Former Name (1)Judith Kikue Centerwall M.d.

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners, PacificSource Health Plans.Insurance ›

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

Bodhi Kikue Kannon M.d. 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 ID547249443

PECOS Enrollment IDI20180323000581

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

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.

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

40 services31 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55432 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

$168.28 typical visit price

range $56.00 – $168.28

Typical copayment $42.07 (range $14.00 – $42.07)

Most-billed visit code 99205

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.53/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

81.79

Promoting Interoperability

100

Improvement Activities

Cost

63.31

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.

DR. GLORIA J. TONG MD

Psychiatry & Neurology (Psychiatry)