NPIMap

Individual provider Active NPI

Krissondra Leigh Klop, D.O.

  • Family Medicine Physician
  • Mandan, ND
National Provider Identifier
1205088515
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12005 Issued in ND
Practice address
910 18TH St NW
Mandan, ND 58554-1612
Phone
(701) 667-5100
NPI assigned
Oct 17, 2008
Last updated
May 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101017842 MI
Family Medicine Physician 207Q00000X 12005 ND Primary

Addresses

Primary practice location

910 18TH St NW
Mandan, ND 58554-1612

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20111103000297 ND Practitioner - Family Practice 1759554926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

2603 E Broadway Ave
Sanford Health Occupational Medicine Clinic
Bismarck, ND 58501-5107
Phone (701) 323-5222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.63 of 100Reported as group
Quality
89.39
Promoting interoperability
100
Improvement activities
40
Cost
76.04

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101017842MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Bismarck Current Accepting new patients
Medcenter One Health Systems DME Current Accepting new patients
Sanford Bismarck CurrentSince Sep 12, 2011 Accepting new patients
Sanford Bismarck Family Medicine CurrentSince Sep 12, 2011 Accepting new patients
Missouri Slope Lutheran Care Center, Inc. Past Accepting new patients
Benedictine Living Communities-Bismarck, Inc. Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Baptist Home, Inc Past Accepting new patients

Locations

1040 Tacoma Ave
Bismarck, ND 58504
Phone (701) 323-6990

2603 E Broadway Ave
Bismarck, ND 58501
Phone (701) 323-5222

3318 N 14th St
Bismarck, ND 58503
Phone (701) 323-8300

910 18th St NW
Mandan, ND 58554
Phone (701) 323-8400

801 21st Ave SE
Minot, ND 58701
Phone (701) 838-3033

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 9

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": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1205088515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 18TH ST NW",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585541612",
            "telephone_number": "701-667-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOP",
        "first_name": "KRISSONDRA",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-17",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101017842",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "12005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandan, ND

Sources for this page

Verify at the official NPI Registry.