Kristine P Pultorak, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036.092252 Issued in IL

Practice address

403 E 1St St
Dixon, IL 61021

Phone

(815) 288-5561

Fax

(815) 285-5859

NPI assigned

Mar 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, WI, IA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com
• Direct secure messaging: kpultorak1019609@direct.unitypoint.org

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.

• Genesis Medical Center, Aledo

  • Critical Access Hospital
  • Aledo, IL
  • NPI 1225380967
  Medicare reassignment NPD
• Genesis Health System

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  Medicare reassignment NPD
• Jackson County Public Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Maquoketa, IA
  • NPI 1689705949
  Medicare reassignment NPD
• Marshfield Clinic Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1952347981
  Medicare reassignment NPD
• MCHS Hospitals Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1093221434

  Emergency Medicine

  Medicare reassignment NPD
• The Finley Hospital

  • Family Medicine Physician
  • Dubuque, IA
  • NPI 1073560462
  Medicare reassignment NPD
• Genesis Medical Center, Aledo

  • Critical Access Hospital
  • Aledo, IL
  • NPI 1427301308
  NPD
• Genesis Medical Center, Aledo

  • Podiatrist
  • Aledo, IL
  • NPI 1972856854
  NPD
• Jackson County Public Hospital

  • Skilled Nursing Facility
  • Maquoketa, IA
  • NPI 1164486551
  NPD
• MCHS Hospitals Inc

  • Clinic/Center
  • Eau Claire, WI
  • NPI 1316416035

  Emergency Medicine

  NPD
• MCHS Hospitals Inc

  • Durable Medical Equipment & Medical Supplies
  • Eau Claire, WI
  • NPI 1558230847
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1306814298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 E 1ST ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213116",
            "telephone_number": "815-288-5561",
            "fax_number": "815-285-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 E 1ST ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "61021",
            "telephone_number": "815-288-5561",
            "fax_number": "815-285-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULTORAK",
        "first_name": "KRISTINE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-092252",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.092252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092252",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "800200006",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "381220005",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Other",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "1000 N Oak Ave",
            "city": "Marshfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544495703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Whitney Poulter
• Tracie L Power, MHP
• David Joseph Powers, M.D.
• Gail E Prendergast, M.D.
• Ann Sheree Prindaville, RN
• Stephanie Ann Raimonde
• Christa Rose Raiter, MHP
• Monissa Rajasri, M.D.
• April R Ramirez, MS, LCPC
• Dan G. Ramirez

• Emergency Medicine Physician in Dixon, IL
• Providers in Dixon, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.