Kurt J Klise, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

24439 Issued in IA

Practice address

250 SW Brookside Dr
Grimes, IA 50111-4900

Phone

(515) 300-3900

Fax

(515) 300-3901

NPI assigned

Sep 26, 2005

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA

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

Family Practice

Education

University of Kansas School of Med (KC/Wich/Sal), 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Medical Center-CentervilleGroup PAC ID 9739077652, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercyone Centerville Medical Center Hospital, Centerville, IA, CCN 161377

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kklise3949312@direct.trinity-health.org

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.

• Mercy Medical Center-Centerville

  • Emergency Care Clinic/Center
  • Centerville, IA
  • NPI 1528018801
  Medicare reassignment Care Compare group NPD
• Mercy Medical Center-Centerville

  dba MercyOne Ottumwa Family and Internal Medicine Clinic

  • Multi-Specialty Clinic/Center
  • Ottumwa, IA
  • NPI 1093360679
  NPD
• Mercy Clinics Inc

  dba MercyOne Clive ENT Care Clinic

  • Clinic/Center
  • Clive, IA
  • NPI 1912187311
  NPD (past)

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

• Mercy Medical Center-Centerville

  dba Mercyone Centerville Medical Center

  • Critical Access Hospital
  • Centerville, IA
  • NPI 1356391635
  Care Compare affiliation

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1871589754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-300-3900",
            "fax_number": "515-300-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 SW BROOKSIDE DR",
            "city": "GRIMES",
            "state": "IA",
            "postal_code": "501114900",
            "telephone_number": "515-300-3900",
            "fax_number": "515-300-3901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "616 10th St",
            "address_purpose": "LOCATION",
            "city": "Perry",
            "state": "IA",
            "postal_code": "502202221",
            "country_code": "US",
            "telephone_number": "515-465-3553",
            "fax_number": "515-465-4319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLISE",
        "first_name": "KURT",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "24439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080195357",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3219469",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• KB Counseling
• Nermina Kekic
• Tiffany Ketcham, DO
• Kleckner Chiropractic Clinic P.C.
• Ethan John Kleckner, D.C.
• Amy Kritenbrink
• Adam Krug
• Samuel Lahr, DC
• Lantern of Hope Services LLC
• Lifestream Clinic

• Family Medicine Physician in Grimes, IA
• Providers in Grimes, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.