NPIMap

Individual provider Active NPI

Kristi Michelle Bohlig, PA-C

  • Physician Assistant
  • Sartell, MN
National Provider Identifier
1770822330
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13049 Issued in MN
Practice address
1990 Connecticut Ave S Ste 100
Sartell, MN 56377-2554
Phone
(202) 575-5953
Fax
(320) 257-5596
NPI assigned
Feb 1, 2013
Last updated
Aug 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13049 MN Primary
Registered Dietitian 133V00000X 923 ND

Addresses

Primary practice location

1990 Connecticut Ave S Ste 100
Sartell, MN 56377-2554

Mailing address

1990 Connecticut Ave S Ste 100
Sartell, MN 56377-2554
Phone (202) 575-5953

Other practice location 1

900 E Broadway Ave
Bismarck, ND 58501-4520
Phone (701) 530-7000

Other identifiers 2

IdentifierTypeStateIssuer
923OtherNDND LICENSURE
13049OtherMNMN LICENSE

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
I20191024001230 MN Practitioner - Physician Assistant 5890934376 Reassigns benefits to 2 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
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
Centracare Health-Paynesville LLCGroup PAC ID 1153555719, shared by 4 NPIs, 61 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

130 1St St NE
Richmond, MN 56368-8183
Phone (320) 597-2122

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

PO Box
Chicago, IL 60673

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Feb 1, 2020 Accepting new patients
Centracare Clinic CurrentSince Feb 1, 2020 Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: kbohlig490463@direct.centracare.com

Organizations & group practices 4

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 6

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": "1359676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1770822330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 CONNECTICUT AVE S STE 100",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772554",
            "telephone_number": "202-575-5953",
            "fax_number": "320-257-5596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 CONNECTICUT AVE S STE 100",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772554",
            "telephone_number": "202-575-5953",
            "fax_number": "320-257-5596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 E Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585014520",
            "country_code": "US",
            "telephone_number": "701-530-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOHLIG",
        "first_name": "KRISTI",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-01",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13049",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ND",
            "license": "923",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND LICENSURE",
            "identifier": "923",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN LICENSE",
            "identifier": "13049",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.