NPIMap

Individual provider Active NPI

Kathy H. Brandli, M.D.

  • Family Medicine Physician
  • Moose Lake, MN
National Provider Identifier
1265467658
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
46671 Issued in MN
Practice address
4570 Cty. Hwy. 61
Moose Lake, MN 55767
Phone
(218) 485-4491
Fax
(218) 485-4724
NPI assigned
Jul 12, 2006
Last updated
Dec 4, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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 46671 MN Primary

Addresses

Primary practice location

4570 Cty. Hwy. 61
Moose Lake, MN 55767

Mailing address

4570 Cty. Hwy. 61
Moose Lake, MN 55767
Phone (218) 485-4491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20040915000177 MN Practitioner - Family Practice 3870560279 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4570 Cty Hwy 61
Moose Lake, MN 55767-9401
Phone (218) 485-4491

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions12
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46671MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Medical Center CurrentSince Mar 1, 2017 Accepting new patients
Pine Medical Center CurrentSince Mar 1, 2017 Accepting new patients
Gateway Family Health Clinic, LTD. Family Medicine CurrentSince Jan 15, 2007 Accepting new patients
Gateway Family Health Clinic, LTD. Current Accepting new patients
Gateway Family Health Clinic, LTD. Family Medicine Past Accepting new patients

Locations

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

707 Lundorff Dr
#1
Sandstone, MN 55072
Phone (320) 245-2250

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDGJBA
  • Direct secure messaging: kathy.brandli@gfhc.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gateway Family Health Clinic, LTD.Sandstone, MN, CCN 243859 Rural health clinic 5% Or Greater Direct Ownership Interest (9.09%)
General Partnership Interest (9.09%)
W-2 Managing Employee (9.09%)		 Jun 1, 2008
Jun 1, 2008
Jun 8, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1265467658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 CTY. HWY. 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "55767",
            "telephone_number": "218-485-4491",
            "fax_number": "218-485-4724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 CTY. HWY. 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "55767",
            "telephone_number": "218-485-4491",
            "fax_number": "218-485-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDLI",
        "first_name": "KATHY",
        "middle_name": "H.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "46671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moose Lake, MN

Sources for this page

Verify at the official NPI Registry.