NPIMap

Individual provider Active NPI

Joellen Kohlman-Petrick, MD

  • Internal Medicine Physician
  • Fergus Falls, MN
National Provider Identifier
1114985454
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
48295 Issued in MN
Practice address
712 S Cascade St
Fergus Falls, MN 56537-2913
Phone
(218) 736-8000
Fax
(218) 739-6718
NPI assigned
May 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 48295 MN Primary
Cardiovascular Disease Physician 207RC0000X 12070 ND

Addresses

Primary practice location

712 S Cascade St
Fergus Falls, MN 56537-2913

Mailing address

712 S Cascade St
Fergus Falls, MN 56537-2913
Phone (218) 736-8000

Other identifiers 1

IdentifierTypeStateIssuer
16483MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111202000218 ND Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6103091129 Reassigns benefits to 2 organizations
I20120614000709 MN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6103091129 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of North Dakota School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prairie Ridge Hospital and Health ServicesGroup PAC ID 0648222349, shared by 3 NPIs, 90 clinicians

Practice addresses (Care Compare)

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2000

619 S Cascade St
Fergus Falls, MN 56537-2943
Phone (218) 736-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.33 of 100Reported as group
Quality
93.68
Promoting interoperability
100
Improvement activities
40
Cost
70.75

Merit-based Incentive Payment System (MIPS)

Final score
88.64 of 100Reported as group
Quality
86.84
Promoting interoperability
100
Improvement activities
40
Cost
75.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48295MNMDInternal Medicine Physician
12070NDMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Region Healthcare Corporation Current Accepting new patients
Lake Region Healthcare Corporation CurrentSince Oct 1, 2025 Accepting new patients
Lake Region Healthcare Corporation CurrentSince Apr 1, 2015 Accepting new patients
Sanford Medical Center Fargo CurrentSince Oct 3, 2011 Accepting new patients
Lake Region Healthcare Corporation CurrentSince Apr 1, 2015 Accepting new patients
Lake Region Healthcare Corporation CurrentSince Nov 1, 2015 Accepting new patients
Sanford Medical Center Fargo Internal Medicine CurrentSince Oct 3, 2011 Accepting new patients
West Central Internal Medicine Past Accepting new patients

Locations

1411 Highway 79 E
Elbow Lake, MN 56531
Phone (218) 685-7300

649 State St NW
Evansville, MN 56326
Phone (218) 948-2040

111 W Vernon Ave
Fergus Falls, MN 56537
Phone (218) 736-5770

619 S Cascade St
Fergus Falls, MN 56537
Phone (218) 736-8451

712 S Cascade St
Fergus Falls, MN 56537

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

24 E 7th St
Morris, MN 56267
Phone (320) 589-4008

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/

Organizations & group practices 8

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 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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1114985454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 S CASCADE ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372913",
            "telephone_number": "218-736-8000",
            "fax_number": "218-739-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 S CASCADE ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372913",
            "telephone_number": "218-736-8000",
            "fax_number": "218-739-6718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHLMAN-PETRICK",
        "first_name": "JOELLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "48295",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ND",
            "license": "12070",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16483",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

Verify at the official NPI Registry.