Individual provider Active NPI

Brayden Lee Krivachek

  • Student in an Organized Health Care Education/Training Program
  • West Des Moines, IA
National Provider Identifier
1245033760
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
8025 Grand Ave
West Des Moines, IA 50266-5360
Phone
(515) 271-1569
NPI assigned
Mar 31, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

8025 Grand Ave
West Des Moines, IA 50266-5360

Mailing address

805 US Highway 52
Decorah, IA 52101-9303
Phone (563) 277-2667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20260101000202 WI Practitioner - Physician Assistant 1355837055 Reassigns benefits to 2 organizations
I20260101000214 MN Practitioner - Physician Assistant 1355837055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Croix Regional Medical CenterGroup PAC ID 9335032184, 131 clinicians

Practice addresses (Care Compare)

12375 Lindstrom LN
Lindstrom, MN 55045-9551
Phone (651) 400-2240

235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3221

Hospital & facility affiliations

  • St Croix Regional Medical Center Hospital, Saint Croix Falls, WI, CCN 521337

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15516MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
St. Croix Regional Medical Center CurrentSince Dec 1, 2025 Accepting new patients
St. Croix Regional Medical Center CurrentSince Dec 1, 2025 Accepting new patients

Locations

1504 190th Ave
Balsam Lake, WI 54810
Phone (715) 825-3278

205 Oak St W
Frederic, WI 54837
Phone (715) 327-5700

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

235 E State St
St Croix Fls, WI 54024
Phone (715) 483-3221

26425 Lakeland Ave S
Webster, WI 54893
Phone (715) 866-4271

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 1

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": "1743379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1245033760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 US HIGHWAY 52",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521019303",
            "telephone_number": "563-277-2667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 GRAND AVE",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502665360",
            "telephone_number": "515-271-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRIVACHEK",
        "first_name": "BRAYDEN",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-31",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Des Moines, IA

Sources for this page

Verify at the official NPI Registry.