KIMBERLY ELAINE FAGEN (M.D.) – Pediatric Radiology Physician, NPI 1194795609
Pediatric Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,801 DIAGNOSTIC RADIOLOGY in MN
Provider Addresses for KIMBERLY ELAINE FAGEN (M.D.)
11995 SINGLETREE LN STE 500
EDEN PRAIRIE, MN 553445349
Phone: (952) 595-1301
Fax: (612) 294-4903
Type: Mailing
600 N WOLFE ST
BALTIMORE, MD 212870005
Phone: (410) 955-5000
Type: Location
11995 Singletree Ln Ste 500
Eden Prairie, MN 553445349
Phone: (952) 595-1301
Fax: (612) 294-4903
Type: Location
501 6th St S
St Petersburg, FL 337014630
Phone: (727) 898-7451
Type: Location
6201 GREENLEIGH AVE
BALTIMORE, MD 212202004
Phone: (410) 933-1340
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: 2011-02-28
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 |
|---|---|---|---|---|
| I20110228000655 | I | Diagnostic Radiology | FL | 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 55344)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| Pulmonary Disease | FL | |
| H O S P I T A L I S T | FL | |
| H O S P I T A L I S T | FL | |
| Pediatric Medicine, Cardiovascular Disease (Cardiology) | FL | |
| Cardiovascular Disease (Cardiology) | FL | |
| Certified Registered Nurse Anesthetist (Crna) | FL | |
| General Surgery | VA | |
| Certified Registered Nurse Anesthetist (Crna) | FL | |
| A N E S T H E S I O L O G Y | LA |
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