NPIMap

Individual provider Active NPI

Kristoph Michael Haak, MD

  • Emergency Medicine Physician
  • Pueblo, CO
National Provider Identifier
1053739573
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DR.0061788 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2781
Phone
(719) 584-4306
Fax
(719) 595-7886
NPI assigned
Apr 1, 2014
Last updated
Jul 18, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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
Emergency Medicine Physician 207P00000X DR.0061788 CO Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2781

Mailing address

400 W 16TH St
Pueblo, CO 81003-2781
Phone (719) 584-4306

Other practice location 1

2301 Holmes St
Truman Medical Center
Kansas City, MO 64108-2640
Phone (816) 404-4175

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190812003316 CO Practitioner - Emergency Medicine 0345542502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Missouri, Kansas City, School of Medicine, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

400 W 16TH St
Pueblo, CO 81003-2745

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.65 of 100Reported as group
Quality
64.78
Improvement activities
40
Cost
70.76

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Emergency Medical Associates Emergency Medicine CurrentSince Apr 1, 2025 Accepting new patients
Southern Colorado Emergency Medical Associates Emergency Medicine CurrentSince Apr 1, 2025 Accepting new patients

Locations

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

899 E Industrial Blvd
Pueblo West, CO 81007
Phone (719) 288-2100

Organizations & group practices 2

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 7

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": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1053739573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032781",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032781",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Holmes St",
            "address_2": "Truman Medical Center",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082640",
            "country_code": "US",
            "telephone_number": "816-404-4175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAAK",
        "first_name": "KRISTOPH",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-01",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0061788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.