NPIMap

Individual provider Active NPI

Kelsey Kienert, M.D.

  • Internal Medicine Physician
  • Neenah, WI
National Provider Identifier
1134501190
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
68772 Issued in WI
Practice address
101 Main St
Neenah, WI 54956
Phone
(920) 720-1463
NPI assigned
Jun 25, 2015
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 68772 WI Primary

Addresses

Primary practice location

101 Main St
Neenah, WI 54956

Mailing address

101 Main St
Neenah, WI 54956-2570
Phone (920) 720-1463

Other practice location 1

1415 Woodland Ave
140
Des Moines, IA 50309-3203
Phone (515) 241-5995

Other practice location 2

1415 Woodland Ave
140
Des Moines, IA 50309-3203
Phone (515) 241-5995

Other names 1

  • Kelsey Marko Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20180822003189 WI Practitioner - Internal Medicine 9931412814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

101 Main St
Neenah, WI 54956-2570
Phone (920) 727-4200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
68772WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Aug 31, 2018 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Aug 31, 2018 Accepting new patients
Tapestry Telehealth PLLC Internal Medicine CurrentSince Aug 22, 2021 Accepting new patients
Iowa Physicians Clinic Medical Foundation Internal Medicine Past Accepting new patients

Locations

99 Hawley Ln
Ste 1102
Stratford, CT 06614

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

101 Main St
Neenah, WI 54956
Phone (920) 727-4200

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Wiplfi, LLPKaukauna, WI, CCN 525617 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2024
Oct 1, 2024
Compassus-Green BayGreen Bay, WI, CCN 521595 Hospice Contracted Managing Employee Apr 5, 2021
Compassus - NeenahNeenah, WI, CCN 521526 Hospice Contracted Managing Employee Apr 5, 2021

Owned or controlled facilities with NPI records 3

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

Organizations & group practices 4

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1134501190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562570",
            "telephone_number": "920-720-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "54956",
            "telephone_number": "920-720-1463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1415 Woodland Ave",
            "address_2": "140",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503093203",
            "country_code": "US",
            "telephone_number": "515-241-5995",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1415 Woodland Ave",
            "address_2": "140",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503093203",
            "country_code": "US",
            "telephone_number": "515-241-5995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIENERT",
        "first_name": "KELSEY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-25",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "68772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "MARKO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.