Active NPI
Fidelis Musau Kiungua, NURSE PRACTITIONER
- Adult Health Nurse Practitioner
- Fairmont, MN
National Provider Identifier
1285037101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 5731
- Practice address
- 800 Medical Center Dr
Fairmont, MN 56031-4575 - Phone
- (507) 238-8100
- NPI assigned
- Oct 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 2462942 | MN | |
| Adult Health Nurse Practitioner | 363LA2200X | 53-76486-051 | KS | |
| Gerontology Nurse Practitioner | 363LG0600X | 53-76486-051 | KS | |
| Adult Health Nurse Practitioner | 363LA2200X | 5731 | MN | Primary |
Addresses
Primary practice location
800 Medical Center Dr
Fairmont, MN 56031-4575
Mailing address
800 Medical Center Dr
Fairmont, MN 56031-4575
Phone (507) 238-8100
Other practice location 1
21615 W 52nd St
Shawnee, KS 66226-2493
Phone (913) 981-3879
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS, MN, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150414000032 | KS | Practitioner - Nurse Practitioner | 4385962885 | Reassigns benefits to 1 organization |
| I20180329001046 | MN | Practitioner - Nurse Practitioner | 4385962885 | Reassigns benefits to 1 organization |
| I20191125001963 | WI | Practitioner - Nurse Practitioner | 4385962885 | Reassigns benefits to 6 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- University of Kansas School of Med (KC/Wich/Sal), 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Langlade Hospital - Hotel Dieu of St Joseph of Antigo WisconsinSt. Luke'S Hospital of Duluth
Practice addresses (Care Compare)
112 E 5TH Ave
Antigo, WI 54409-2710
Phone (715) 623-2331
915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5555
Hospital & facility affiliations
- St Lukes Hospital
- Langlade Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.59 of 100
- Quality
- 80.64
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.66
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.84 of 100
- Quality
- 86.21
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.25
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2462942 | MN | MD | Adult Health Nurse Practitioner |
| 53-76486-051 | KS | MD | Gerontology Nurse Practitioner |
Practice roles
Locations
29980 Network Pl
Chicago, IL 60673
1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860
915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352
112 E 5th Ave
Antigo, WI 54409
Phone (715) 623-2331
400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318
1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850
3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200
1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111
2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074
401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700
240 Maple St
Woodruff, WI 54568
Phone (715) 356-8000
Interoperability endpoints
- fidelis.kiungua@marshfieldclinichealthsystem.cernerdirect.com
Organizations & group practices 29
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.
-
- Rural Health Clinic/Center
- Elcho, WI
- NPI 1831251040
WI
-
- Critical Access Hospital
- Antigo, WI
- NPI 1639187412
WI
-
- Clinic/Center
- Stevens Point, WI
- NPI 1144991340
WI
-
- General Acute Care Hospital
- Duluth, MN
- NPI 1801835970
-
- Certified Registered Nurse Anesthetist
- Duluth, MN
- NPI 1003860792
-
- Rural Health Clinic/Center
- Two Harbors, MN
- NPI 1235946054
-
- Community Based Hospice Care Agency
- Duluth, MN
- NPI 1265486963
Hospital & facility affiliations 28
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Endocrinology, Diabetes & Metabolism Physician
- Duluth, MN
- NPI 1093769796
Hospital
-
- Vascular & Interventional Radiology Physician
- Duluth, MN
- NPI 1124732110
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560470400000",
"number": "1285037101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8100"
}
],
"practiceLocations": [
{
"address_1": "21615 W 52nd St",
"address_purpose": "LOCATION",
"city": "Shawnee",
"state": "KS",
"postal_code": "662262493",
"country_code": "US",
"telephone_number": "913-981-3879",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIUNGUA",
"first_name": "FIDELIS",
"middle_name": "MUSAU",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-06",
"last_updated": "2019-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MN",
"license": "2462942",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "KS",
"license": "53-76486-051",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "KS",
"license": "53-76486-051",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MN",
"license": "5731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.