NPIMap

Individual provider Active NPI

Kristen Theobald Braig, MD

  • Family Medicine Physician
  • Bellefontaine, OH
National Provider Identifier
1265422950
Registry record updated Apr 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-08-1723 Issued in OH
Practice address
2211 Timber TRL
Maple Leaf Family and Sports Medicine
Bellefontaine, OH 43311-9036
Phone
(937) 592-3808
Fax
(937) 593-8404
NPI assigned
Oct 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35-08-1723 OH Primary

Addresses

Primary practice location

2211 Timber TRL
Maple Leaf Family and Sports Medicine
Bellefontaine, OH 43311-9036

Mailing address

9055 Oconnors Point Dr
Belle Center, OH 43310-9300
Phone (937) 843-4195

Other identifiers 1

IdentifierTypeStateIssuer
2443056MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20040303000317 OH Practitioner - Family Practice 4789571886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Cincinnati College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maple Leaf Family and Sports Medicine, LLCGroup PAC ID 7416844592, 4 clinicians

Practice addresses (Care Compare)

2211 Timber TRL
Bellefontaine, OH 43311-9036
Phone (937) 592-3808

Hospital & facility affiliations

  • Otterbein Universal Home Health & Hospice Home health agency, Bellefontaine, OH, CCN 367404
  • High Point Home Health, LTD Home health agency, Bellefontaine, OH, CCN 367798
  • Mary Rutan Hospital Hospital, Bellefontaine, OH, CCN 360197
  • Mercy Health St Ritas Medical Center Hospital, Lima, OH, CCN 360066
  • Memorial Hospital Hospital, Marysville, OH, CCN 360092

Merit-based Incentive Payment System (MIPS)

Final score
85.5 of 100Reported as apm
Quality
71.52
Promoting interoperability
95.57
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Maple Leaf Family and Sports Medicine, LLC Family Medicine CurrentSince Aug 1, 2003 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

2211 Timber Trl
Bellefontaine, OH 43311
Phone (937) 592-3808

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JAAAAA
  • Direct secure messaging: kristen.braig@mlfsm.eclinicaldirectplus.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 6

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": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303862400000",
    "number": "1265422950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9055 OCONNORS POINT DR",
            "city": "BELLE CENTER",
            "state": "OH",
            "postal_code": "433109300",
            "telephone_number": "937-843-4195",
            "fax_number": "937-593-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 TIMBER TRL",
            "address_2": "MAPLE LEAF FAMILY AND SPORTS MEDICINE",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119036",
            "telephone_number": "937-592-3808",
            "fax_number": "937-593-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAIG",
        "first_name": "KRISTEN",
        "middle_name": "THEOBALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2011-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-08-1723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2443056",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellefontaine, OH

Sources for this page

Verify at the official NPI Registry.