NPIMap

Individual provider Active NPI

Kristin J Bietz, FNP

  • Nurse Practitioner
  • Mitchell, SD
National Provider Identifier
1144714205
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP001385 Issued in SD
Practice address
120 W 6TH Ave
Mitchell, SD 57301-1920
Phone
(605) 292-6262
NPI assigned
Jun 21, 2018
Last updated
Jun 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP001385 SD Primary

Addresses

Primary practice location

120 W 6TH Ave
Mitchell, SD 57301-1920

Mailing address

PO Box 3100
Carbondale, IL 62902-3100
Phone (618) 529-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20180725000988 SD Practitioner - Nurse Practitioner 3274880042 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

605 N Foster St
Mitchell, SD 57301-2902
Phone (605) 995-5756

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CP001385SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Heart Hospital of South Dakota LLC CurrentSince Jan 1, 2019 Accepting new patients
Avera McKennan CurrentSince Nov 1, 2019 Accepting new patients
Avera Queen of Peace Current Accepting new patients
Avera Queen of Peace CurrentSince Dec 21, 2019 Accepting new patients
Heart Hospital of South Dakota LLC CurrentSince Jan 1, 2019 Accepting new patients
Avera McKennan CurrentSince Nov 1, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Avera Queen of Peace CurrentSince Dec 21, 2019 Accepting new patients

Locations

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

605 N Foster St
Mitchell, SD 57301
Phone (605) 995-5756

1000 E 23rd St
Ste 230
Sioux Falls, SD 57105
Phone (605) 322-6900

4500 W 69th St
Sioux Falls, SD 57108
Phone (605) 977-7000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529539200000",
    "number": "1144714205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3100",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023100",
            "telephone_number": "618-529-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W 6TH AVE",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011920",
            "telephone_number": "605-292-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIETZ",
        "first_name": "KRISTIN",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-21",
        "last_updated": "2018-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP001385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mitchell, SD

Sources for this page

Verify at the official NPI Registry.