NPIMap

Individual provider Active NPI

Kailey Witt, MD

  • Family Medicine Physician
  • Perham, MN
National Provider Identifier
1114280831
Registry record updated Feb 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59624 Issued in MN
Practice address
1000 Coney St W
Perham, MN 56573-2102
Phone
(218) 347-1200
NPI assigned
Jun 18, 2012
Last updated
Feb 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2016

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
Family Medicine Physician 207Q00000X 59624 MN Primary

Addresses

Primary practice location

1000 Coney St W
Perham, MN 56573-2102

Mailing address

1000 Coney St W
Perham, MN 56573-2102
Phone (218) 347-1200

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
I20151026001583 MN Practitioner - Family Practice 7113156415 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perham Hospital DistrictGroup PAC ID 2264327766, shared by 5 NPIs, 40 clinicians

Practice addresses (Care Compare)

1000 Coney St W
Perham, MN 56573-2102
Phone (218) 347-1200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
91.62
Promoting interoperability
100
Improvement activities
40
Cost
66.36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Perham Hospital District Family Medicine CurrentSince Apr 9, 2020 Accepting new patients
Perham Hospital District CurrentSince Apr 9, 2020 Accepting new patients
Perham Hospital District Current Accepting new patients
Perham Hospital District Current Accepting new patients
Sanford Clinic North Family Medicine Past Accepting new patients

Locations

105 Otter Dr
Ottertail, MN 56571
Phone (218) 367-6111

1000 Coney St W
Perham, MN 56573
Phone (218) 347-1200

Organizations & group practices 5

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 9

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455494400000",
    "number": "1114280831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CONEY ST W",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565732102",
            "telephone_number": "218-347-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CONEY ST W",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565732102",
            "telephone_number": "218-347-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "KAILEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2016-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "59624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perham, MN

Sources for this page

Verify at the official NPI Registry.