Individual provider Active NPI

Kristin Leigh Docter, APNP

  • Nurse Practitioner
  • Stoughton, WI
National Provider Identifier
1205312923
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9317-33 Issued in WI
Practice address
225 Church St
Stoughton, WI 53589-1801
Phone
(608) 877-2777
Fax
(608) 877-2774
NPI assigned
Jul 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 198855 WI
Registered Nurse 163W00000X 041429640 IL
Nurse Practitioner 363L00000X 209017967 IL
Family Nurse Practitioner 363LF0000X 9317-33 WI
Nurse Practitioner 363L00000X 9317-33 WI Primary

Addresses

Primary practice location

225 Church St
Stoughton, WI 53589-1801

Mailing address

1808 W Beltline Hwy
Madison, WI 53713-2334
Phone (608) 250-1497

Other practice location 1

635 N Fairbanks Ct
Chicago, IL 60611
Phone (312) 694-2273

Other practice location 2

635 N Fairbanks Ct
Chicago, IL 60611
Phone (312) 694-2273

Other practice location 3

635 N Fairbanks Ct
Chicago, IL 60611
Phone (312) 694-2273

Other practice location 4

635 N Fairbanks Ct
Chicago, IL 60611
Phone (312) 694-2273

Other identifiers 1

IdentifierTypeStateIssuer
1205312923MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kdocter355155@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191114002674 WI Practitioner - Nurse Practitioner 9931452422 Reassigns benefits to 1 organization

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
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

225 Church St
Stoughton, WI 53589-1801
Phone (608) 877-2777

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
198855WIMDRegistered Nurse
9317-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc. CurrentSince May 4, 2020 Accepting new patients
Dean Health Systems, Inc CurrentSince May 4, 2020 Accepting new patients

Locations

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

225 Church St
Stoughton, WI 53589
Phone (608) 877-2700

Interoperability endpoints

  • Direct secure messaging: kdocter355155@direct-ehr-ssmhc.com

Organizations & group practices 2

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 4

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": "1531699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1205312923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 W BELTLINE HWY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132334",
            "telephone_number": "608-250-1497",
            "fax_number": "608-250-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CHURCH ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891801",
            "telephone_number": "608-877-2777",
            "fax_number": "608-877-2774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "635 N Fairbanks Ct",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60611",
            "country_code": "US",
            "telephone_number": "312-694-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "635 N Fairbanks Ct",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60611",
            "country_code": "US",
            "telephone_number": "312-694-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "635 N Fairbanks Ct",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60611",
            "country_code": "US",
            "telephone_number": "312-694-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "635 N Fairbanks Ct",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60611",
            "country_code": "US",
            "telephone_number": "312-694-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOCTER",
        "first_name": "KRISTIN",
        "middle_name": "LEIGH",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-16",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "198855",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041429640",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017967",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "9317-33",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9317-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205312923",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdocter355155@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kdocter355155@direct-ehr-ssmhc.com",
            "address_1": "225 Church St",
            "city": "Stoughton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535891801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "225 Church St",
            "city": "Stoughton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535891801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stoughton, WI

Sources for this page

Verify at the official NPI Registry.