NPIMap

Individual provider Active NPI

Kristin Mary Dahms

  • Physician Assistant
  • Crandon, WI
National Provider Identifier
1205911831
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1494 Issued in WI
Practice address
400 W Glen St
Crandon, WI 54520-1355
Phone
(715) 623-9763
NPI assigned
Oct 25, 2006
Last updated
Oct 16, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1494 WI Primary

Addresses

Primary practice location

400 W Glen St
Crandon, WI 54520-1355

Mailing address

400 W Glen St
Crandon, WI 54520-1355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20090924000336 WI Practitioner - Physician Assistant 8628124369 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

Practice addresses (Care Compare)

240 Maple St
Woodruff, WI 54568-9190
Phone (715) 356-8140

400 W Glen St
Crandon, WI 54520-1355
Phone (715) 478-3318

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.84 of 100Reported as group
Quality
86.21
Promoting interoperability
100
Improvement activities
40
Cost
73.25

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1494WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Oct 22, 2012 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Oct 22, 2012 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

112 E 5th Ave
Antigo, WI 54409
Phone (715) 623-2331

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

1020 Kabel Ave
Rhinelander, WI 54501
Phone (715) 361-2805

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

Interoperability endpoints

  • Direct secure messaging: kdahms168422@direct.aspirus.org

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

Hospital & facility affiliations 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1205911831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W GLEN ST",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545201355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W GLEN ST",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545201355",
            "telephone_number": "715-623-9763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHMS",
        "first_name": "KRISTIN",
        "middle_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crandon, WI

Sources for this page

Verify at the official NPI Registry.