NPIMap

Individual provider Active NPI

Kevin R Wentworth, MD

  • Family Medicine Physician
  • Detroit Lakes, MN
National Provider Identifier
1639270069
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44499 Issued in MN
Practice address
1027 Washington Avenue
Detroit Lakes, MN 56501-3409
Phone
(218) 847-5611
NPI assigned
Sep 26, 2006
Last updated
Apr 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44499 MN Primary

Addresses

Primary practice location

1027 Washington Avenue
Detroit Lakes, MN 56501-3409

Mailing address

415 Jefferson St North
Tri-County Health Care
Wadena, MN 56482-1296
Phone (218) 631-3510

Other practice location 1

401 Douglas Ave
Tri-County Health Care - Henning Clinic
Henning, MN 56551
Phone (218) 583-2953

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031124000098 MN Practitioner - Emergency MedicinePractitioner - Family Practice 5193629988 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakewood Health SystemGroup PAC ID 1052229671, shared by 15 NPIs, 107 clinicians

Practice addresses (Care Compare)

49725 County
Staples, MN 56479-5280
Phone (218) 894-1515

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakewood Health System CurrentSince Jan 2, 2023 Accepting new patients
Sanford Health Network North CurrentSince Feb 21, 2018 Accepting new patients
Lakewood Health System Current Accepting new patients
Sanford Health Network North CurrentSince Feb 21, 2018 Accepting new patients
Sanford Health Network North Current Accepting new patients
Lakewood Health System CurrentSince Jan 2, 2023 Accepting new patients
Lakewood Health System Current Accepting new patients
Center for Psychiatric Care PastSince Aug 28, 2000 Accepting new patients
St. Francis Medical Center Past Accepting new patients
Fergus Falls Medical Group, P.a. Family Medicine Past Accepting new patients

Locations

49725 County 83
Staples, MN 56479
Phone (218) 894-1033

1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747

3001 Sanford Pkwy
Thief Rvr Fls, MN 56701
Phone (218) 681-4240

Interoperability endpoints

  • Direct secure messaging: kwentworth633964@direct.ochin.org

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1639270069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 JEFFERSON ST NORTH",
            "address_2": "TRI-COUNTY HEALTH CARE",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821296",
            "telephone_number": "218-631-3510",
            "fax_number": "218-631-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVENUE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-847-5611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Douglas Ave",
            "address_2": "Tri-County Health Care - Henning Clinic",
            "address_purpose": "LOCATION",
            "city": "Henning",
            "state": "MN",
            "postal_code": "56551",
            "country_code": "US",
            "telephone_number": "218-583-2953",
            "fax_number": "218-631-4521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENTWORTH",
        "first_name": "KEVIN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "44499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

Verify at the official NPI Registry.