NPIMap

Individual provider Active NPI

Carrie Lynn Kern

  • Family Medicine Physician
  • Ellsworth, WI
National Provider Identifier
1013233709
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
55415 Issued in MN
Practice address
530 W Cairns St
Ellsworth, WI 54011-9225
Phone
(715) 273-5061
NPI assigned
Apr 20, 2010
Last updated
Jan 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 55415 MN Primary

Addresses

Primary practice location

530 W Cairns St
Ellsworth, WI 54011-9225

Mailing address

530 W Cairns St
Ellsworth, WI 54011-9225
Phone (651) 267-5000

Other identifiers 2

IdentifierTypeStateIssuer
1013233709MedicaidWI
1013233709MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ckern88406@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110914000747 MN Practitioner - Family Practice 5991976375 Reassigns benefits to 1 organization
I20130806000491 WI Practitioner - Family Practice 5991976375 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic Health System-Southeast Minnesota RegionGroup PAC ID 4385556703, shared by 9 NPIs, 550 clinicians

Practice addresses (Care Compare)

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (507) 373-2384

530 W Cairns St
Ellsworth, WI 54011-9225
Phone (715) 273-5061

701 Hewitt Blvd
Red Wing, MN 55066-2848
Phone (651) 267-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southeast Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Nov 14, 2017 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Mar 13, 2021 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Nov 14, 2017 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Mar 13, 2021 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

701 Hewitt Blvd
Red Wing, MN 55066
Phone (507) 377-6285

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

403 N Maple St
Ellsworth, WI 54011
Phone (715) 273-5821

530 W Cairns St
Ellsworth, WI 54011
Phone (715) 273-5061

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1013233709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 W CAIRNS ST",
            "city": "ELLSWORTH",
            "state": "WI",
            "postal_code": "540119225",
            "telephone_number": "651-267-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 W CAIRNS ST",
            "city": "ELLSWORTH",
            "state": "WI",
            "postal_code": "540119225",
            "telephone_number": "715-273-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERN",
        "first_name": "CARRIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "55415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013233709",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013233709",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckern88406@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "530 W Cairns St",
            "city": "Ellsworth",
            "state": "WI",
            "country_code": "US",
            "postal_code": "540119225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ellsworth, WI

Sources for this page

Verify at the official NPI Registry.