NPIMap

Individual provider Active NPI

Kelly Marie Evans-Hullinger, MD

  • Internal Medicine Physician
  • Denver, CO
National Provider Identifier
1871869057
Registry record updated Aug 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0055106 Issued in CO
Practice address
1721 E 19TH Ave Ste 520
Denver, CO 80218-1243
Phone
(720) 754-8134
Fax
(303) 869-2258
NPI assigned
Apr 1, 2012
Last updated
Aug 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0055106 CO Primary

Addresses

Primary practice location

1721 E 19TH Ave Ste 520
Denver, CO 80218-1243

Mailing address

4900 S Monaco St
#210
Denver, CO 80237-3486
Phone (720) 754-8134

Other identifiers 1

IdentifierTypeStateIssuer
99688310MedicaidCO

Other names 1

  • Kelly Evans Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20160819001922 SD Practitioner - Internal Medicine 6709106685 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Sanford School of Medicine of University of South Dakota, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of BrookingsGroup PAC ID 1052307105, 112 clinicians
Rural Health Care IncGroup PAC ID 3476447541, 156 clinicians

Practice addresses (Care Compare)

400 22ND Ave
Brookings, SD 57006-2447
Phone (605) 697-9500

400 22ND Ave
Brookings, SD 57006-2450
Phone (605) 697-9500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0055106COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Brookings Current Accepting new patients
Rural Health Care, Inc. CurrentSince Nov 1, 2020 Accepting new patients
Rural Health Care, Inc CurrentSince Nov 1, 2020 Accepting new patients
City of Brookings CurrentSince Sep 1, 2016 Accepting new patients
City of Brookings CurrentSince Sep 1, 2016 Accepting new patients

Locations

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

400 22nd Ave
Ste 1
Brookings, SD 57006
Phone (605) 697-9500

Interoperability endpoints

  • Direct secure messaging: kelly.evanshullinger@avera.sdhealthlink.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brookings Health SystemBrookings, SD, CCN 431509 Hospice Contracted Managing Employee Mar 17, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • City of Brookings

    dba Brookings Health System

    • Community Based Hospice Care Agency
    • Brookings, SD
    • NPI 1306928494

    Contracted Managing Employee

    CMS ownership

Organizations & group practices 5

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 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1333238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439424000000",
    "number": "1871869057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 S MONACO ST",
            "address_2": "#210",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802373486",
            "telephone_number": "720-754-8134",
            "fax_number": "303-869-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 E 19TH AVE STE 520",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181243",
            "telephone_number": "720-754-8134",
            "fax_number": "303-869-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS-HULLINGER",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-01",
        "last_updated": "2015-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0055106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99688310",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "EVANS",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.