NPIMap

Individual provider Active NPI

Kathlyn Elise Callenius, DO

  • Neurology Physician
  • Brainerd, MN
National Provider Identifier
1144712084
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
70968 Issued in MN
Practice address
2024 S 6TH St
Brainerd, MN 56401-4529
Phone
(218) 828-2880
NPI assigned
Jun 6, 2018
Last updated
Oct 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X OT018685 PA
Student in an Organized Health Care Education/Training Program 390200000X
Neurology Physician 2084N0400X 70968 MN Primary

Addresses

Primary practice location

2024 S 6TH St
Brainerd, MN 56401-4529

Mailing address

2024 S 6TH St
Brainerd, MN 56401-4529
Phone (218) 828-2880

Other practice location 1

120 East Second St
3rd Floor
Erie, PA 16507
Phone (814) 877-8000

Other names 1

  • Kathlyn Elise Jensen Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address UPMChospitals@upmcdirect.com
CONNECT URL https://www.essentiahealth.org/find-facility/profile/essentia-health-st-josephs-brainerd-clinic/

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
I20221028002031 MN Practitioner - Neurology 9234485780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Lake Erie Col of Osteo Med at Seton Hill Univ, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

2024 S 6TH St
Brainerd, MN 56401-4529
Phone (218) 828-7100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT018685PAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph's Medical Center CurrentSince Oct 24, 2022 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
St. Joseph's Medical Center CurrentSince Oct 24, 2022 Accepting new patients
St Joseph's Medical Center Past Accepting new patients

Locations

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

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 11

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": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1144712084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014529",
            "telephone_number": "218-828-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014529",
            "telephone_number": "218-828-2880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 East Second St",
            "address_2": "3rd Floor",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "16507",
            "country_code": "US",
            "telephone_number": "814-877-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLENIUS",
        "first_name": "KATHLYN",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-06",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "OT018685",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "70968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UPMChospitals@upmcdirect.com",
            "affiliation": "N",
            "address_1": "600 Grant St Fl 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192739",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.essentiahealth.org/find-facility/profile/essentia-health-st-josephs-brainerd-clinic/",
            "affiliation": "N",
            "address_1": "2024 S 6th St",
            "city": "Brainerd",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564014529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATHLYN",
            "last_name": "JENSEN",
            "middle_name": "ELISE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brainerd, MN

Sources for this page

Verify at the official NPI Registry.