Jonathan L. Kilstrom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

081384 Issued in IA

Practice address

933 E Pierce St
Council Bluffs, IA 51503-4626

Phone

(712) 396-6111

Fax

(712) 396-7026

NPI assigned

Jun 27, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA, NE2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pgfhgs Holdings LLCGroup PAC ID 9537695481, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047

Merit-based Incentive Payment System (MIPS)

Final score

67.97 of 100Reported as apm

Quality

34.29

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Pgfhgs Holdings LLC

  • Specialist
  • Omaha, NE
  • NPI 1629884523

  IA

  Medicare reassignment Care Compare group
• Clarinda Regional Health Center

  • Family Medicine Physician
  • Clarinda, IA
  • NPI 1629196241
  Medicare reassignment NPD
• Jennie Edmundson Memorial Hospital

  • Emergency Medicine Physician
  • Council Bluffs, IA
  • NPI 1942251269

  Physician Assistant

  Medicare reassignment NPD
• Clarinda Regional Health Center

  • Critical Access Hospital
  • Clarinda, IA
  • NPI 1366486946
  NPD

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

• Jennie Edmundson Memorial Hospital

  • General Acute Care Hospital
  • Council Bluffs, IA
  • NPI 1457448755
  Care Compare affiliation

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1740695899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2797",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681032797",
            "telephone_number": "402-354-4230",
            "fax_number": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E PIERCE ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034626",
            "telephone_number": "712-396-6111",
            "fax_number": "712-396-7026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5950 University Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "West Des Moines",
            "state": "IA",
            "postal_code": "502667756",
            "country_code": "US",
            "telephone_number": "515-875-9070",
            "fax_number": "515-875-9071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILSTROM",
        "first_name": "JONATHAN",
        "middle_name": "L.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09172",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "081384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740695899",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420680355-12",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Elizabeth Bean Kidambi, DNP, APRN-NP, AGACNP
• Kids Therapy Corner
• Britley Kierscht
• Jeffrey Phillip Kiley, D.P.M.
• Erica A. Kilnoski, P.A.
• Thomas Kimberly, DDS
• Kindred
• Demianna King, H.I.S.
• Jonathan Kingsley, OD
• Mark Gregory Kinnaman, CADC

• Physician Assistant in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.