NPIMap

Individual provider Active NPI

Dennis Kiesel, P.A.-C

  • Surgical Physician Assistant
  • Reno, NV
National Provider Identifier
1154326676
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA1490 Issued in NV
Practice address
555 N Arlington Ave
Reno, NV 89503-4723
Phone
(775) 786-3040
Fax
(775) 786-1386
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 9794 MN
Physician Assistant 363A00000X PA1490 NV
Surgical Physician Assistant 363AS0400X PA1490 NV Primary
Medical Physician Assistant 363AM0700X PA1490 NV

Addresses

Primary practice location

555 N Arlington Ave
Reno, NV 89503-4723

Mailing address

1000 E 1St St
Ste 404
Duluth, MN 55805-2297
Phone (775) 786-3040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 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
I20100105000802 MN Practitioner - Physician Assistant 0648311100 Reassigns benefits to 5 organizations
I20161220000416 WI Practitioner - Physician Assistant 0648311100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Associates of Duluth PAGroup PAC ID 1951294065, 37 clinicians

Practice addresses (Care Compare)

1000 E 1St St
Duluth, MN 55805-2297
Phone (218) 722-5513

1405 Progress Pkwy
Suite 1
Virginia, MN 55792-3068
Phone (218) 722-5513

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Range Regional Health Services CurrentSince Apr 15, 2021 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Feb 1, 2020 Accepting new patients
Range Regional Health Services CurrentSince Apr 15, 2021 Accepting new patients

Locations

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

Organizations & group practices 7

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 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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1154326676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST",
            "address_2": "STE 404",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "775-786-3040",
            "fax_number": "775-786-1386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N ARLINGTON AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895034723",
            "telephone_number": "775-786-3040",
            "fax_number": "775-786-1386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIESEL",
        "first_name": "DENNIS",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "9794",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1490",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NV",
            "license": "PA1490",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1490",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.