NPIMap

Individual provider Active NPI

Kathy E Wimmer, MD

  • Family Medicine Physician
  • Pillager, MN
National Provider Identifier
1700855814
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30204 Issued in MN
Practice address
680 Pillsbury St N
Pillager, MN 56473-2507
Phone
(218) 746-4527
Fax
(218) 746-4528
NPI assigned
Mar 14, 2006
Last updated
Jan 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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 30204 MN Primary

Addresses

Primary practice location

680 Pillsbury St N
Pillager, MN 56473-2507

Mailing address

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 829-2861

Other identifiers 1

IdentifierTypeStateIssuer
889588100MedicaidMN

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
I20040109000198 MN Practitioner - Family Practice 0345140281

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

523 N 3Rd St
Brainerd, MN 56401-3098

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30204MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brainerd Medical Center Inc CurrentSince Feb 6, 2012 Accepting new patients
St. Joseph's Medical Center CurrentSince Nov 1, 2003 Accepting new patients
St Joseph's Medical Center CurrentSince Nov 1, 2003 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
Brainerd Medical Center Inc. CurrentSince Feb 6, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
St. Joseph's Medical Center Past Accepting new patients

Locations

13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

680 Pillsbury St N
Pillager, MN 56473
Phone (218) 746-4527

Organizations & group practices 7

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 10

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1700855814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 N 3RD ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013054",
            "telephone_number": "218-829-2861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 PILLSBURY ST N",
            "city": "PILLAGER",
            "state": "MN",
            "postal_code": "564732507",
            "telephone_number": "218-746-4527",
            "fax_number": "218-746-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMMER",
        "first_name": "KATHY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "30204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889588100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pillager, MN

Sources for this page

Verify at the official NPI Registry.