Kim L Wilde, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

65959 Issued in MN

Practice address

1001 E Superior St Ste L401
Duluth, MN 55802

Phone

(218) 249-7960

Fax

(218) 249-7997

NPI assigned

May 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX, MN2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Luke'S Hospital of Duluth

  • Rehabilitation Hospital Unit
  • Duluth, MN
  • NPI 1902845068
  Medicare reassignment NPD
• Eastern Shoshone Tribe

  • Federal Public Health Clinic/Center
  • Fort Washakie, WY
  • NPI 1770328718

  TX

  Medicare reassignment NPD
• Great Plains Tribal Chairmen'S Health Board

  • Pharmacy
  • Rapid City, SD
  • NPI 1376105452

  TX

  Medicare reassignment NPD
• Quentin N Burdick Comprehensive Health Care Facility

  • Rural Acute Care Hospital
  • Belcourt, ND
  • NPI 1952346934

  TX

  Medicare reassignment NPD
• Rosebud Indian Health Service

  • General Acute Care Hospital
  • Rosebud, SD
  • NPI 1194757369

  TX

  Medicare reassignment NPD
• US Health Dept of Health & Human Services

  • Rural Health Clinic/Center
  • Poplar, MT
  • NPI 1972694602

  TX

  Medicare reassignment NPD
• Wagner Indian Health Service Health Center

  • Clinic/Center
  • Wagner, SD
  • NPI 1326066796

  TX

  Medicare reassignment NPD
• Winnebago Tribe of Nebraska

  • Clinic/Center
  • Winnebago, NE
  • NPI 1033608328

  TX

  Medicare reassignment NPD
• Eagle Butte Indian Health Service Hospital

  • Public Health or Welfare Agency
  • Eagle Butte, SD
  • NPI 1558395848

  TX

  Medicare reassignment
• St. Luke'S Hospital of Duluth

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Duluth, MN
  • NPI 1073480968
  NPD
• St. Luke'S Hospital of Duluth

  • Family Medicine Physician
  • Duluth, MN
  • NPI 1306870654
  NPD
• Rosebud Indian Health Service

  • Ambulatory Surgical Clinic/Center
  • Rosebud, SD
  • NPI 1790955128
  NPD

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1891744140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E SUPERIOR ST STE L401",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022207",
            "telephone_number": "218-249-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E SUPERIOR ST STE L401",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55802",
            "telephone_number": "218-249-7960",
            "fax_number": "218-249-7997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 1st Ave SE",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "SD",
            "postal_code": "572014402",
            "country_code": "US",
            "telephone_number": "605-886-8482",
            "fax_number": "605-884-4300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDE",
        "first_name": "KIM",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-06",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SD",
            "license": "2534",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "65959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000743",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "1001 E Superior St Ste L401",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Wilberscheid
• Jessica L Wilcken
• Aaron Joseph Wilcox, PT
• Jacob Avery Wilcox, MD
• Rachel Marie Wilcox, MD
• Wilderness Wellness Chiropractic LLC
• Robert Earl Wildwood, LPN
• Sonja Wildwood, LPCC
• Elizabeth Jean Wilhelmson, P.T.
• Krista Wilhelmson, MD

• Internal Medicine Physician in Duluth, MN
• Providers in Duluth, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.