KELLY L DZIEDZIC (PA-C) – Physician Assistant, NPI 1568437879
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
Provider Addresses for KELLY L DZIEDZIC (PA-C)
2090 Woodwinds Dr
Woodbury, MN 551252522
Phone: (651) 968-5801
Fax: (651) 968-5899
Type: Location
Commerce Drive, Woodbury, Washington County, Minnesota, 55129, United States
WOODBURY, MN 551254925
Phone: (651) 968-5042
Fax: (651) 968-5904
Type: Mailing
1000 W 140TH ST UNIT 201
BURNSVILLE, MN 553374833
Phone: (952) 808-3000
Fax: (952) 808-3001
Type: Location
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: 2003-11-14
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 |
|---|---|---|---|---|
| I20031114000298 | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 29 | 28 | $0 |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | 22 | 22 | $0 |
Insurance plans in this area (ZIP 55125)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | MN | 20610 | Aspiration and/or injection of large joint or joint capsule | 56 | 44 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Orthopedic Surgery | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | TX |
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