Katelyn Corine Krueger, PA-C
Individual provider Active NPI Physician Assistant · New London, MN
NPI 1104493568 · NPPES record last updated Jun 4, 2021
Key facts
- NPI
- 1104493568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 20819 Highway 23 NE
New London, MN 56273-9402 - Phone
- (320) 760-5675
- NPI assigned
- Jun 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Glacial Ridge Hospital District
Practice addresses (Care Compare)
10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-4521
417 Franklin St S
Glenwood, MN 56334-1518
Phone (320) 634-5157
Hospital & facility affiliations
- Glacial Ridge Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210901000318 | MN | Practitioner - Physician Assistant | 2769888668 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glacial Ridge Hospital District | Current |
Accepting new patients | |
| Glacial Ridge Hospital District | Current |
Accepting new patients | |
| Glacial Ridge Hospital District | Current | Accepting new patients | |
| Glacial Ridge Hospital District | Past | Accepting new patients |
Locations
10 4th Ave SE
Glenwood, MN 56334
Phone (320) 634-5157
417 Franklin St S
Glenwood, MN 56334
Phone (320) 634-5157
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/glac-1755385c
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
20819 Highway 23 NE
New London, MN 56273-9402
Mailing address
20819 Highway 23 NE
New London, MN 56273-9402
Phone (320) 760-5675
Other names
- Katelyn Corine Lundblad
Other providers in New London, MN
- Fischer Laser Eye Center, LLC
- Nicholas Goelz
- Megan Anastasia Grimsley
- Grace Catherine Illies
- Independent School District 345
- Krupke Chiropractic PLLC
- Brett Nathan Krupke
- Kwo 5 Star, Inc
- Living Services Foundation New London LLC
- Living Services Foundation/ New London LLC
All providers in New London, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.