KELSEY KOSTREBA (PA-C) – Surgical Physician Assistant, NPI 1033753546
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
Provider Addresses for KELSEY KOSTREBA (PA-C)
1700 Highway 25 N Ste 120
Buffalo, MN 553131930
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
5700 Bottineau Blvd Ste 100
Crystal, MN 554293184
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
480 Osborne Rd NE Ste 100
Fridley, MN 554322781
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
3366 Oakdale Ave N Ste 200
Robbinsdale, MN 554222962
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
2600 39th Ave NE
Minneapolis, MN 554214379
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
1495 County Road 101 N
Plymouth, MN 554473078
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
11855 Ulysses St NE Ste 210
Blaine, MN 554344181
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
15450 Highway 7 Ste 225
Minnetonka, MN 553453522
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
7600 France Ave S Ste 4100
Edina, MN 554356027
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
6565 France Ave S Ste 350
Edina, MN 554352159
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
7373 France Ave S Ste 408
Edina, MN 554354549
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Location
9825 HOSPITAL DR STE 105
MAPLE GROVE, MN 553694769
Phone: (763) 780-6699
Fax: (763) 420-0500
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-12-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20191217000220 | I | Physician Assistant | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55313)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pulmonary Disease | CO | |
| Qualified Audiologist | MN | |
| Family Practice | MN | |
| - | MN | |
| Family Practice | MN | |
| Nurse Practitioner | ND | |
| - | MN | |
| - | MN | |
| - | MN | |
| - | MN |
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