NPIMap

Individual provider Active NPI

Kristen J Bracklein, D.O.

  • Family Medicine Physician
  • Tecumseh, MI
National Provider Identifier
1730255357
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO205724 Issued in OR
Practice address
900 Blood Rd
Tecumseh, MI 49286-9575
Phone
(432) 212-2944
Fax
(734) 661-0406
NPI assigned
Nov 27, 2006
Last updated
Mar 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101012874 MI
Family Medicine Physician 207Q00000X K5173 TX
Family Medicine Physician 207Q00000X DO205724 OR Primary

Addresses

Primary practice location

900 Blood Rd
Tecumseh, MI 49286-9575

Mailing address

7700 Cody LN
Apt3306
Sachse, TX 75048-6629

Other practice location 1

6501 Legacy Dr
Plano, TX 75024-3612
Phone (972) 431-2345

Other practice location 2

3175 Smith Rd
Lambertville, MI 48144-9434
Phone (734) 856-5494

Other practice location 3

920 SW Range Dr
Waldport, OR 97394-9634
Phone (541) 563-3197

Other identifiers 1

IdentifierTypeStateIssuer
29935601MedicaidTX

Other names 1

  • Dr. Kristen J Pak / Kozma Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbracklein236251@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MI, OR3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20100802000715 TX Practitioner - Family Practice 6507814068 Reassigns benefits to 1 organization
I20191105000742 MI Practitioner - Family Practice 6507814068 Reassigns benefits to 3 organizations
I20211222002414 OR Practitioner - Family Practice 6507814068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

N10561 Grandview LN
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10561 Granview LN
Grand View Hospital
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10565 Grand View Lane
Ironwood, MI 49938-9622

N10565 Grandview Lane
Ironwood, MI 49938-9622

N10565 Grandview LN Aspirus Ironwood
Ironwood, MI 49938-9622
Phone (715) 843-1067

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO205724ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Ironwood Hospital & Clinics Inc. CurrentSince Feb 23, 2026 Accepting new patients
Lane County Oregon CurrentSince Dec 1, 2021 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Medhealth CurrentSince May 18, 2015 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Feb 23, 2026 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Feb 23, 2026 Accepting new patients
Hillsdale Community Health Center CurrentSince Feb 20, 2024 Accepting new patients
Medhealth Family Medicine CurrentSince May 18, 2015 Accepting new patients
Hillsdale Community Health Center CurrentSince Feb 20, 2024 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. Family Medicine CurrentSince Feb 23, 2026 Accepting new patients
Allied Institute of Medicine, PLLC Family Medicine Past Accepting new patients
Hillsdale Community Health Center Past Accepting new patients
Samaritan Pacific Health Services, Inc. Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

168 S Howell St
Hillsdale, MI 49242
Phone (517) 437-4451

183 Hillsdale St
Hillsdale, MI 49242

240 W Carleton Rd
Hillsdale, MI 49242
Phone (517) 437-7040

N10561 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

N10565 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

1022 Green Acres Rd
Eugene, OR 97408
Phone (541) 682-7206

151 W 7th Ave
Eugene, OR 97401
Phone (541) 682-4041

2073 Olympic St
Springfield, OR 97477
Phone (541) 682-3530

613 S Highway 78
Wylie, TX 75098
Phone (972) 941-8700

Interoperability endpoints

  • Direct secure messaging: kbracklein131787@direct.promedica.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1730255357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 CODY LN",
            "address_2": "APT3306",
            "city": "SACHSE",
            "state": "TX",
            "postal_code": "750486629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 BLOOD RD",
            "city": "TECUMSEH",
            "state": "MI",
            "postal_code": "492869575",
            "telephone_number": "432-212-2944",
            "fax_number": "734-661-0406"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6501 Legacy Dr",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750243612",
            "country_code": "US",
            "telephone_number": "972-431-2345",
            "fax_number": "972-431-5999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3175 Smith Rd",
            "address_purpose": "LOCATION",
            "city": "Lambertville",
            "state": "MI",
            "postal_code": "481449434",
            "country_code": "US",
            "telephone_number": "734-856-5494",
            "fax_number": "734-856-7184",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "920 SW Range Dr",
            "address_purpose": "LOCATION",
            "city": "Waldport",
            "state": "OR",
            "postal_code": "973949634",
            "country_code": "US",
            "telephone_number": "541-563-3197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACKLEIN",
        "first_name": "KRISTEN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101012874",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K5173",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO205724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29935601",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbracklein236251@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "920 SW Range Dr",
            "city": "Waldport",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973949634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "PAK / KOZMA",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tecumseh, MI

Sources for this page

Verify at the official NPI Registry.