Kathy H. Brandli, M.D.
Individual provider Active NPI Family Medicine Physician · Moose Lake, MN
NPI 1265467658 · NPPES record last updated Dec 4, 2012
Key facts
- NPI
- 1265467658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 46671 (MN)
- Practice address
- 4570 Cty. Hwy. 61
Moose Lake, MN 55767 - Phone
- (218) 485-4491
- Fax
- (218) 485-4724
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 32
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- 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
- Gateway Family Health Clinic, LTD.
Practice addresses (Care Compare)
4570 Cty Hwy 61
Moose Lake, MN 55767-9401
Phone (218) 485-4491
Hospital & facility affiliations
- Essentia Health Moose Lake Home Care
- Essentia Health Moose Lake
- Essentia Health Sandstone
- St Lukes Hospital
- Community Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of skin lesions | 12 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Gateway Family Health Clinic, LTD. |
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 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040915000177 | MN | Practitioner - Family Practice | 3870560279 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Family Health Clinic, LTD. | Current | Accepting new patients | |
| Gateway Family Health Clinic, LTD. | Family Medicine | Current |
Accepting new patients |
| Pine Medical Center | Current |
Accepting new patients | |
| Pine Medical Center | 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
- https://fhir4.healow.com/fhir/r4/JDGJBA
- kathy.brandli@gfhc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 46671 | MN | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 014934900 | Medicaid | MN |
Other providers in Moose Lake, MN
- Sharyn Barney
- John Sutherland Barry
- Bruce A. Beaman
- Brianna D Bentley
- Josie Benzie
- Blake Steven Chapman
- Luann Joyce Charboneau
- Raymond G. Christensen
- Heather Cronemiller
- Darci Kay Dahl
All providers in Moose Lake, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.