Kristen Wikholm Kieley, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A130814 Issued in CA

Practice address

1100 Monterey St Ste 200
San Luis Obispo, CA 93401-3102

Phone

(805) 542-9700

Fax

(805) 542-0584

NPI assigned

Jun 5, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other names 1

• Kristen Myrtle Wikholm Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Luis Imaging Medical Group IncGroup PAC ID 2860618766, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• French Hospital Medical Center Hospital, San Luis Obispo, CA, CCN 050232
• Marian Regional Medical Center Hospital, Santa Maria, CA, CCN 050107
• Adventist Health Sierra Vista Hospital, San Luis Obispo, CA, CCN 050506

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• San Luis Imaging Medical Group, Inc

  • Diagnostic Radiology Physician
  • San Luis Obispo, CA
  • NPI 1649682840
  Medicare reassignment Care Compare group

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

• Dignity Community Care

  • General Acute Care Hospital
  • San Luis Obispo, CA
  • NPI 1881760452
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Santa Maria, CA
  • NPI 1760510937
  Care Compare affiliation
• Sierra Vista Hospital, Inc.

  • General Acute Care Hospital
  • San Luis Obispo, CA
  • NPI 1639101116
  Care Compare affiliation

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

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415664000000",
    "number": "1780810606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 LA TAPADERA LN",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449479",
            "telephone_number": "805-260-6785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MONTEREY ST STE 200",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013102",
            "telephone_number": "805-542-9700",
            "fax_number": "805-542-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIELEY",
        "first_name": "KRISTEN",
        "middle_name": "WIKHOLM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-05",
        "last_updated": "2014-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MN",
            "license": "25161",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "25161",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "MN",
            "license": "25161",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A130814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "WIKHOLM",
            "middle_name": "MYRTLE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John A Khan-Variba, MD
• Elham Khodabandeloo, L.AC.
• Kallie Elizabeth Kidder
• Lani Kidman
• Kidney Dialysis Center of San Luis Obispo,LLC
• Daniel Kielty, LVN
• George S Kienle, DO
• Yusuke Kihira, DPM
• Christine Denise Kilcline, M.D.
• Denise Kilimnik

• Diagnostic Radiology Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; 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.