Kellan Brett Klubben, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

84153-20 Issued in WI

Practice address

11040 N State Rd 77
Hayward, WI 54843

Phone

(715) 934-4910

NPI assigned

Apr 14, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

Medical Services, IncGroup PAC ID 9436061363, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tamarack Health Hayward Medical Center Hospital, Hayward, WI, CCN 521336

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Medical Services, Inc

  • Critical Access Hospital
  • Hayward, WI
  • NPI 1912992827
  Medicare reassignment Care Compare group NPD
• Medical Services, Inc

  • Rural Health Clinic/Center
  • Hayward, WI
  • NPI 1386316537
  NPD

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

• Medical Services, Inc

  • Critical Access Hospital
  • Hayward, WI
  • NPI 1912992827
  Care Compare affiliation

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1144800905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 N STATE RD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "54843",
            "telephone_number": "715-934-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 N STATE RD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "54843",
            "telephone_number": "715-934-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLUBBEN",
        "first_name": "KELLAN",
        "middle_name": "BRETT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2024-09-11",
        "certification_date": "2021-06-30",
        "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": "WI",
            "license": "84153-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyson May Kelsey, PA-C, MED, LAT, ATC
• Constance M Kelsey, SLP
• Kathleen Ann Kephart
• Susan L Kettler, MSSW, LCSW
• Thomas Lee Kintzinger, M.D.
• Tracy Lynn Kocemba, OD
• Martha Krasean, RN, CNP
• Jessica Marie Kratz, PA-C
• Kelsey Kreyer, PHARMD
• Theodore Allen Kuhns, CNA

• Family Medicine Physician in Hayward, WI
• Providers in Hayward, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.