NPIMap

Individual provider Active NPI

Tracy L Kahl, D. O.

  • Family Medicine Physician
  • Onawa, IA
National Provider Identifier
1104812783
Registry record updated Mar 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3374 Issued in IA
Practice address
1614 Diamond Street PL
Onawa, IA 51040-1554
Phone
(712) 423-1525
Fax
(712) 423-2528
NPI assigned
Sep 20, 2005
Last updated
Mar 18, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3374 IA Primary

Addresses

Primary practice location

1614 Diamond Street PL
Onawa, IA 51040-1554

Mailing address

1614 Diamond Street PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Other identifiers 1

IdentifierTypeStateIssuer
2215277MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20040923000916 IA Practitioner - Family Practice 6901874270 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Burgess Health CenterGroup PAC ID 0143131516, shared by 7 NPIs, 13 clinicians
Family Medicine Clinic, P.C.Group PAC ID 0547159824, 10 clinicians

Practice addresses (Care Compare)

1600 Diamond St
Onawa, IA 51040-1548
Phone (712) 423-2311

1614 Diamond St PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3347IAMDFamily Medicine Physician
3374IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medicine Clinic, PC Family Medicine CurrentSince Mar 1, 2013 Accepting new patients
Family Medicine Clinic, P.C. Family Medicine CurrentSince Mar 1, 2013 Accepting new patients
Burgess Health Center Family Medicine CurrentSince May 10, 2013 Accepting new patients
Burgess Health Center CurrentSince May 10, 2013 Accepting new patients
Burgess Health Center Current Accepting new patients
Burgess Health Center Family Medicine Past Accepting new patients
Manning Family Healthcare Clinic PC Family Medicine PastSince Sep 1, 2006 Accepting new patients

Locations

1600 Diamond St
Onawa, IA 51040
Phone (712) 423-2311

1614 Diamond Street Pl
Onawa, IA 51040
Phone (712) 423-1525

Interoperability endpoints

  • Direct secure messaging: tracykahl@fmcc.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Medicine Clinic, P.C.Onawa, IA, CCN 163831 Rural health clinic General Partnership Interest (25%) Jun 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363564800000",
    "number": "1104812783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAHL",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "D. O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2013-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2215277",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onawa, IA

Sources for this page

Verify at the official NPI Registry.