Jacalyn Anne Bossen Kawiecki, MD, MHA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

42926 Issued in MN

Practice address

1412 W 4TH St
Red Wing Healthcare Community
Red Wing, MN 55066-2107

Phone

(651) 388-2843

Fax

(651) 388-9502

NPI assigned

May 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Dr. Jacalyn Anne Dahl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378425600000",
    "number": "1659329621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6235 WENTWORTH AVE",
            "address_2": "J.A.B. KAWIECKI, INC.; D.B.A. EXCEL REHABILITATION",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231540",
            "telephone_number": "612-481-1233",
            "fax_number": "612-886-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 W 4TH ST",
            "address_2": "RED WING HEALTHCARE COMMUNITY",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662107",
            "telephone_number": "651-388-2843",
            "fax_number": "651-388-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWIECKI",
        "first_name": "JACALYN",
        "middle_name": "ANNE BOSSEN",
        "name_prefix": "Dr.",
        "credential": "MD, MHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2013-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "42926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206922900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP37218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "611855422B159",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MINNESOTA",
            "identifier": "81Q7G72KA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34247000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "963371033094",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACALYN",
            "last_name": "DAHL",
            "middle_name": "ANNE",
            "prefix": "DR.",
            "credential": "MD, MHA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jill Ann Kaiser
• Keith Randall Kaiser
• Mansi Jayesh Kanuga, M.D,
• Christopher Allen Kasal, M.D.
• Kathryn Zoff Seivert PHD LP PA
• Gregory A Kays, MD
• Autumn Margaret Kelly
• Megan Kathleen Kelly
• Ryan Patrick Kelly
• Samantha Kennedy

• Physical Medicine & Rehabilitation Physician in Red Wing, MN
• Providers in Red Wing, MN by specialty
• Physical Medicine & Rehabilitation Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.