Dr. Kyle Shipley
Radiology (Diagnostic Radiology)

Address: 166 4th St E, Saint Paul, MN 55101-1421
Phone: 6512922000

Dr. Kyle Shipley (NPI# 1841408200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1841408200
Entity Type Individual
Full Name Dr. Kyle Shipley
Credential MD
Gender Male
Practice Address 166 4th St E
Saint Paul
MN 55101-1421
Practice Telephone 6512922000
Mailing Address 166 4th St E
St Paul
MN 55101-1421
Mailing Telephone 6512922000
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2007-05-18
Last Update Date 2016-01-14

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 2085R0202X Radiology · Diagnostic Radiology Allopathic & Osteopathic Physicians 59256 MN

Other Provider Identifier

State Identifier Issuer Type Code
MN 1841408200 MEDICAID

Physician Overview

NPI 1841408200
PAC ID by PECOS 6507995339
Professional Enrollment ID I20150521002513
Full Name Kyle Shipley
Organization Legal Name ALTRU HEALTH SYSTEM
Phone Number 6512922000
Gender M
Medical School UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Graduation Year 2005
Primary Specialty DIAGNOSTIC RADIOLOGY
Group Practice PAC ID 1355251604
Number of Group Practice Members 439
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
240106 REGIONS HOSPITAL
240066 LAKEVIEW MEMORIAL HOSPITAL
240210 HEALTHEAST ST JOHN'S HOSPITAL
240038 ALLINA UNITED HOSPITAL
521308 AMERY HOSPITAL & CLINIC

Office Location

Street Address 166 4TH ST E
City SAINT PAUL
State MN
Zip Code 55101-1421

Providers in the same location

NPI Name Taxonomy Address Enumeration
1558367789 Richard N. Aizpuru Radiology 166 4th St E, Saint Paul, MN 55101-1421 2005-06-22
1982115754 Erin Kaslow Social Worker 166 4th St E, Saint Paul, MN 55101-1421 2017-10-19
1518477454 Sarah Jean Boehne Social Worker 166 4th St E, Saint Paul, MN 55101-1421 2017-10-05
1861934788 South Metro Human Services-act Purple Case Management 166 4th St E, Suite 200, Saint Paul, MN 55101-1421 2016-11-09
1952843864 South Metro Human Services-act Blue Case Management 166 4th St E, Suite 200, Saint Paul, MN 55101-1421 2016-11-09
1023560257 Cheryl Bertsch Pharmacist 166 4th St E, Saint Paul, MN 55101-1421 2016-11-04
1912365669 Tracy Jost Nurse Practitioner 166 4th St E, Saint Paul, MN 55101-1421 2016-02-09
1801251509 Kristin E. Jacobs Psychologist 166 4th St E, Saint Paul, MN 55101-1421 2015-12-22
1255708780 United Family Practice Health Center Family Medicine 166 4th St E, Saint Paul, MN 55101-1421 2015-09-01
1952778656 Laura Lynett Counselor 166 4th St E, Saint Paul, MN 55101-1421 2015-08-28
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1538638945 Brooke Elizabeth Wickman Dietetic Technician, Registered Brooke Wickman, 401 Sibley Street Apt B120, Saint Paul, MN 55101 2018-11-14
1922590488 Diane Mcleod Physician Assistant Healthpartners Regions Specialty Clinics, 640 Jackson St - Mail Stop 11109e, Saint Paul, MN 55101 2018-05-31
1699284919 Eric Mcgillis Emergency Medicine Regions Hospital - Emergency Medicine, 11102f, 640 Jackson St, St Paul, MN 55101 2017-09-29
1073051751 Hannah Elizabeth Rosenthal Physician Assistant 640 Jackson St # Ms 11102m, Saint Paul, MN 55101 2017-02-02
1992182323 Theresa Annette Cashdollar-powell Social Worker 640 Jackson, St Paul, MN 55101 2015-05-06
1851641419 Lisa Rae Caturia Occupational Therapy Assistant 640 Jackson St, 8th Floor, St Paul, MN 55101 2012-09-11
1558619478 Rph On The Go Community/Behavioral Health 172 E 6th Street, 704, Saint Paul, MN 55101 2012-08-27
1184994212 Duyen Truong Pharmacist 604 Jackson Street, St. Paul, MN 55101 2012-01-05
1083992432 Emma Norton Services Community/Behavioral Health 670 N. Robert St., St. Paul, MN 55101 2011-08-02
1285926212 Daniel James Miller Student in an Organized Health Care Education/Training Program 200 University Avenue East, St. Paul, MN 55101 2011-05-10
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Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1477819985 Adrienne Vargo Radiology 250 Thompson St, Saint Paul, MN 55102 2012-04-09
1568589083 Jamie L. Fort Radiology 166 4th St E Ste 100, Saint Paul, MN 55101-1474 2007-03-22
1558367789 Richard N. Aizpuru Radiology 166 4th St E, Saint Paul, MN 55101-1421 2005-06-22
1558785311 Megan Elgethun Radiology 166 4th St E, Saint Paul, MN 55101-1421 2014-02-13
1043643059 Voyageur Imaging,llc Radiology 393 Dunlap St N, Suite Ll40, Saint Paul, MN 55104-4200 2013-08-13
1447556584 Sameer Nevile Radiology 166 4th St E Ste 100, Saint Paul, MN 55101-1474 2011-02-08
1114246113 Andrew Bunney Radiology 166 4th St E, Ste. 100, Saint Paul, MN 55101 2010-05-31
1679899389 Eric Carolan Radiology 166 4th St E, Saint Paul, MN 55101-1421 2010-04-20
1558686030 Timothy Meehan Radiology 166 4th St E Ste 100, Saint Paul, MN 55101-1474 2010-03-29
1811127905 Joshua B Johnson Radiology 166 4th St E, Saint Paul, MN 55101-1421 2009-07-23
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Competitor

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City SAINT PAUL
Zip Code 55101

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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