Robert L Kistner Jr., M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35056109 Issued in OH

Practice address

2755 Silver Creek Rd Ste 111
Bullhead City, AZ 86442-8343

Phone

(928) 704-7163

NPI assigned

Aug 19, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ, CO, OH, WV4 enrollments

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 4

Specialty

General Surgery

Education

University of Cincinnati College of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Camden-Clark Physician CorporationGroup PAC ID 5294885661, 345 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Camden Clark Medical Center Hospital, Parkersburg, WV, CCN 510058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gehrkistn@yourcarecommunity.org

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.

• Camden-Clark Physician Corporation

  • Surgery Physician
  • Parkersburg, WV
  • NPI 1710125430
  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians North Specialty Care LLC

  • Surgery Physician
  • Toledo, OH
  • NPI 1306468418
  Medicare reassignment NPD
• Mercy Medical Partners Northern Region Specialty Care LLC

  • Surgery Physician
  • Defiance, OH
  • NPI 1730701749
  Medicare reassignment NPD
• Colorado Plains Physician Practices LLC

  • Cardiovascular Disease Physician
  • Fort Morgan, CO
  • NPI 1821042409
  NPD
• Mercy Health Physicians North Specialty Care LLC

  • Customized Equipment (DME)
  • Toledo, OH
  • NPI 1235891672
  NPD
• Mercy Medical Partners Northern Region Specialty Care LLC

  • Customized Equipment (DME)
  • Defiance, OH
  • NPI 1043972482
  NPD
• Mercy Health Physicians Kentucky LLC

  • Family Medicine Physician
  • Paducah, KY
  • NPI 1922243690

  Surgery

  NPD (past)

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

• Camden Clark Memorial Hospital Corporation

  • General Acute Care Hospital
  • Parkersburg, WV
  • NPI 1508160268
  Care Compare affiliation
• Camden Clark Memorial Hospital Corporation

  • General Acute Care Hospital
  • Parkersburg, WV
  • NPI 1699704254
  Care Compare affiliation

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1063404572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50970",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850760970",
            "telephone_number": "480-706-6151",
            "fax_number": "480-706-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 SILVER CREEK RD STE 111",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864428343",
            "telephone_number": "928-704-7163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 E Ray Rd Ste 9-154",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852258735",
            "country_code": "US",
            "telephone_number": "480-706-6151",
            "fax_number": "480-706-8908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISTNER",
        "first_name": "ROBERT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "AZ20804",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35056109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0491638",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130170",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "robert.kistner.1@1575.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct adress",
            "address_1": "2755 Silver Creek Rd Ste 111",
            "city": "Bullhead City",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864428343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• La Laser Center PC, a Professional Medical Corporation

• Surgery Physician in Bullhead City, AZ
• Providers in Bullhead City, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.