NPIMap

Individual provider Active NPI

Kristin Michelle Pomplun, FNP

  • Family Nurse Practitioner
  • Willmar, MN
National Provider Identifier
1104467935
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F08190242 Issued in MN
Practice address
515 19TH Ave SW
Willmar, MN 56201-5274
Phone
(320) 235-2720
NPI assigned
Oct 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F08190242 MN Primary

Addresses

Primary practice location

515 19TH Ave SW
Willmar, MN 56201-5274

Mailing address

5542 112TH Ave NE
Spicer, MN 56288-8401
Phone (320) 894-9403

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20200401000514 MN Practitioner - Nurse Practitioner 2769811470 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare Health-Paynesville LLCGroup PAC ID 1153555719, shared by 4 NPIs, 61 clinicians
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

200 W 1St St
Paynesville, MN 56362-1445
Phone (320) 243-3767

Hospital & facility affiliations

  • Centracare Home Health Home health agency, Waite Park, MN, CCN 247117
  • Centracare - Paynesville Hospital Hospital, Paynesville, MN, CCN 241349
  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F08190242MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Cloud Hospital CurrentSince Jul 15, 2020 Accepting new patients
St. Cloud Hospital Current Accepting new patients
Centracare Clinic CurrentSince Jul 15, 2020 Accepting new patients
Centracare Health-Paynesville LLC CurrentSince Mar 1, 2020 Accepting new patients
Centracare Clinic Current Accepting new patients
St. Cloud Hospital CurrentSince Jul 15, 2020 Accepting new patients
Centracare Health-Paynesville LLC Current Accepting new patients
Centracare Clinic CurrentSince Jul 15, 2020 Accepting new patients
Centracare Health-Paynesville LLC CurrentSince Mar 1, 2020 Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

200 W 1st St
Paynesville, MN 56362
Phone (320) 243-3767

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Interoperability endpoints

  • Direct secure messaging: kpomplun513291@direct.centracare.com

Organizations & group practices 10

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": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1104467935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5542 112TH AVE NE",
            "city": "SPICER",
            "state": "MN",
            "postal_code": "562888401",
            "telephone_number": "320-894-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015274",
            "telephone_number": "320-235-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMPLUN",
        "first_name": "KRISTIN",
        "middle_name": "MICHELLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-02",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "F08190242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willmar, MN

Sources for this page

Verify at the official NPI Registry.