Individual provider Active NPI

Kelly Elizabeth Klinker, MD

  • Colon & Rectal Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1033320064
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
01066585A Issued in IN
Practice address
11104 Parkview Circle Dr Ste 320
Fort Wayne, IN 46845-1733
Phone
(260) 266-5300
Fax
(260) 266-5314
NPI assigned
May 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 139359 MT
Colon & Rectal Surgery Physician 208C00000X 01066585A IN Primary

Addresses

Primary practice location

11104 Parkview Circle Dr Ste 320
Fort Wayne, IN 46845-1733

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other practice location 1

1333 Surgical Services Way
Kalispell, MT 59901-4844
Phone (406) 751-5392

Other identifiers 3

IdentifierTypeStateIssuer
200945020MedicaidIN
P00737804OtherINR.R. MEDICARE
000000621930OtherINANTHEM

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address kklinker6086@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
Direct Messaging Address Krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center, Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240715002544 MT Practitioner - Colorectal Surgery (Proctology) 7618048968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Indiana University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1333 Surgical Services Way
Kalispell, MT 59901-4844
Phone (406) 751-5392

1600 Hospital Way
Whitefish, MT 59937-7849
Phone (406) 863-3500

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 751-6725

320 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 756-3526

350 Heritage Way
Kalispell, MT 59901-3167

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy85

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01066585AINMDColon & Rectal Surgery Physician
139359MTMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Jul 15, 2024 Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center, Inc CurrentSince Jul 15, 2024 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

1333 Surgical Services Way
Kalispell, MT 59901
Phone (406) 751-5392

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org
  • Direct secure messaging: kklinker6086@direct.parkviewexchange.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1033320064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11104 PARKVIEW CIRCLE DR STE 320",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451733",
            "telephone_number": "260-266-5300",
            "fax_number": "260-266-5314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 Surgical Services Way",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599014844",
            "country_code": "US",
            "telephone_number": "406-751-5392",
            "fax_number": "406-751-5406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLINKER",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MT",
            "license": "139359",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "IN",
            "license": "01066585A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200945020",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R.R. MEDICARE",
            "identifier": "P00737804",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000621930",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kklinker6086@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 320",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 320",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 320",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center, Inc",
            "address_1": "1333 Surgical Services Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599014844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.