Active NPI
Jane Grace Killgore, MD
- Obstetrics & Gynecology Physician
- Bemidji, MN
National Provider Identifier
1477571032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 25351
- Practice address
- 1233 34TH St NW
Bemidji, MN 56601-5112 - Phone
- (218) 333-5289
- Fax
- (218) 759-5021
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 25351 | MN | Primary |
Addresses
Primary practice location
1233 34TH St NW
Bemidji, MN 56601-5112
Mailing address
1233 34TH St NW
Bemidji, MN 56601-5112
Phone (218) 333-5289
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180800100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25351 | MN | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321833600000",
"number": "1477571032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1233 34TH ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566015112",
"telephone_number": "218-333-5289",
"fax_number": "218-759-5021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1233 34TH ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566015112",
"telephone_number": "218-333-5289",
"fax_number": "218-759-5021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLGORE",
"first_name": "JANE",
"middle_name": "GRACE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2011-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MN",
"license": "25351",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "180800100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.