NPIMap

Individual provider Active NPI

Kimberly M Keniry, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Duluth, MN
National Provider Identifier
1346668183
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
65105 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805
Phone
(218) 786-8364
NPI assigned
Mar 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 66340 WI
Physical Medicine & Rehabilitation Physician 208100000X 65105 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805

Mailing address

1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-4222

Other practice location 1

9200 W Wisconsin Ave
Milwaukee, WI 53226
Phone (414) 805-7342

Other identifiers 1

IdentifierTypeStateIssuer
1346668183MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180726000762 WI Practitioner - Physical Medicine and Rehabilitation 2163708579 Reassigns benefits to 2 organizations
I20190529000764 MN Practitioner - Physical Medicine and Rehabilitation 2163708579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
Duluth, MN 55811-5640
Phone (218) 786-5360

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65105MNMDPhysical Medicine & Rehabilitation Physician
66340WIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD. CurrentSince Jul 29, 2019 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jul 7, 2018 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Jun 6, 2018 Accepting new patients
The Duluth Clinic, LTD CurrentSince Jul 29, 2019 Accepting new patients
SMDC Medical Center Past Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

W126N7338 Flint Dr
Ste 200
Menomonee Falls, WI 53051

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

3200 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 334-5533

Organizations & group practices 8

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 5

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": "1396137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1346668183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53226",
            "country_code": "US",
            "telephone_number": "414-805-7342",
            "fax_number": "414-805-7348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENIRY",
        "first_name": "KIMBERLY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-30",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "66340",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "65105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346668183",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.