Kevin J Bardwell, MD
Individual provider Active NPI Family Medicine Physician · Baxter, MN
NPI 1801875869 · NPPES record last updated Jul 8, 2019
Key facts
- NPI
- 1801875869
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 36003 (MN)
- Practice address
- 13060 Isle Dr
Baxter, MN 56425-8331 - Phone
- (218) 828-2880
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Nebraska College of Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Josephs Medical Center
Practice addresses (Care Compare)
13060 Isle Dr
Baxter, MN 56425-8331
Phone (218) 828-2880
Hospital & facility affiliations
- Essentia Health St Joseph'S Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050615000108 | MN | Practitioner - Family Practice | 1456254390 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36003 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph'S Medical Center | Current | Accepting new patients | |
| St Joseph'S Medical Center | Current |
Accepting new patients | |
| St Joseph'S Medical Center | Current |
Accepting new patients | |
| St. Joseph'S Medical Center | Past | Accepting new patients |
Locations
523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394
13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920
301 2nd Ave NW
Staples, MN 56479
Phone (218) 894-7870
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36003 | MN | Yes |
Addresses
Primary practice location
13060 Isle Dr
Baxter, MN 56425-8331
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0572149 | Medicaid | IA | |
| 41084933956001C072 | Other | CHAMPUS | |
| 62B41BA | Other | MN | BCBS |
| 0118449 | Other | MN | MEDICA |
| 21851 | Other | MN | AMERICAS PPO |
| 32013500 | Medicaid | WI | |
| 204283500 | Medicaid | MN | |
| 105085 | Other | MN | UCARE |
| NA2951006282 | Other | MN | PREFERRED ONE |
| 080163236 | Other | RR MEDICARE | |
| HP15832 | Other | MN | HEALTH PARTNERS |
Other providers in Baxter, MN
- Kaitlin Kristine Bakker
- Christopher Ball
- Brianne Joan Baloga
- Sophie Samantha Balster
- Andrew Banal
- Aubrey Rose Bastyr
- Ashlee Bauer
- Baxter Chiropractic PA
- Baxter Dental
- Baxter Dental PLLC
All providers in Baxter, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.