Individual provider Active NPI

Kaitlyn Rae Wirtz, PA-C

  • Physician Assistant
  • Washburn, ND
National Provider Identifier
1649839846
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1177 Border LN
Washburn, ND 58577-4102
Phone
(701) 462-3396
Fax
(701) 463-3422
NPI assigned
Jun 11, 2019
Last updated
Jun 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X ND Primary

Addresses

Primary practice location

1177 Border LN
Washburn, ND 58577-4102

Mailing address

PO Box 280
Turtle Lake, ND 58575-0280
Phone (701) 448-2331

Other practice location 1

220 5th Ave W
Turtle Lake, ND 58575-4324
Phone (701) 448-2334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190820004064 ND Practitioner - Physician Assistant 7517295116 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Alexius Medical CenterGroup PAC ID 8426960865, shared by 12 NPIs, 239 clinicians

Practice addresses (Care Compare)

1177 Border LN
Washburn, ND 58577-4102
Phone (701) 462-3396

220 5TH Ave W
Turtle Lake, ND 58575-4324
Phone (701) 448-2331

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.48 of 100Reported as group
Quality
73.03
Promoting interoperability
100
Improvement activities
40
Cost
71.91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Alexius Medical Center CurrentSince Jul 22, 2025 Accepting new patients
St Alexius Medical Center CurrentSince Aug 1, 2019 Accepting new patients
St. Alexius Medical Center CurrentSince Aug 1, 2019 Accepting new patients
Garrison Memorial Hospital CurrentSince Feb 28, 2025 Accepting new patients
Community Memorial Hospital Past Accepting new patients

Locations

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

437 3rd Ave SE
Garrison, ND 58540
Phone (701) 463-2245

220 5th Ave W
Turtle Lake, ND 58575
Phone (701) 448-2331

1177 Border Ln
Washburn, ND 58577
Phone (701) 462-3396

Interoperability endpoints

  • Direct secure messaging: kwirtz506068@achce.catholichealth.net

Organizations & group practices 5

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 3

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": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1649839846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "TURTLE LAKE",
            "state": "ND",
            "postal_code": "585750280",
            "telephone_number": "701-448-2331",
            "fax_number": "701-448-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 BORDER LN",
            "city": "WASHBURN",
            "state": "ND",
            "postal_code": "585774102",
            "telephone_number": "701-462-3396",
            "fax_number": "701-463-3422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 5th Ave W",
            "address_purpose": "LOCATION",
            "city": "Turtle Lake",
            "state": "ND",
            "postal_code": "585754324",
            "country_code": "US",
            "telephone_number": "701-448-2334",
            "fax_number": "701-448-2441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIRTZ",
        "first_name": "KAITLYN",
        "middle_name": "RAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washburn, ND

Sources for this page

Verify at the official NPI Registry.