Kimberly Spivack, MSN
Individual provider Active NPI Acute Care Nurse Practitioner · Glenwood, MN
NPI 1376357814 · NPPES record last updated Feb 5, 2025
Key facts
- NPI
- 1376357814
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- 12514 (MN)
- Practice address
- 10 4TH Ave SE
Glenwood, MN 56334-1820 - Phone
- (320) 634-4521
- NPI assigned
- Feb 5, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Glacial Ridge Hospital District
Practice addresses (Care Compare)
111 Pleasant Ave N
Brooten, MN 56316-4715
Phone (320) 346-2272
417 Franklin St S
Glenwood, MN 56334-1518
Phone (320) 634-5157
Hospital & facility affiliations
- Glacial Ridge Hospital
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250403001488 | MN | Practitioner - Nurse Practitioner | 5799209490 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12514 | MN | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glacial Ridge Hospital District | Current |
Accepting new patients | |
| Glacial Ridge Hospital District | Current | Accepting new patients | |
| Glacial Ridge Hospital District | Current | Accepting new patients |
Locations
10 4th Ave SE
Glenwood, MN 56334
Phone (320) 634-5157
417 Franklin St S
Glenwood, MN 56334
Phone (320) 634-5157
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/glac-1755385c
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 12514 | MN | |
| Acute Care Nurse Practitioner | 363LA2100X | 12514 | MN | Yes |
Addresses
Primary practice location
10 4TH Ave SE
Glenwood, MN 56334-1820
Mailing address
1240 W Main St
Paynesville, MN 56362-1040
Phone (701) 740-1890
Other providers in Glenwood, MN
- Scott William Ringdahl
- Melissa A Saari
- Jeffrey Alan Schlueter
- Joseph Anthony Schneiderhan
- Shopko Stores Operating Co LLC
- Rebeka A Srbu
- The Evangelical Lutheran Good Samaritan Society
- Joshua David Thomas
- Jodie Louise Trill
- Trumm Drug, Inc.
All providers in Glenwood, MN · Acute Care Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2025. 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.
- 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.