Kevin M Anderson, M.D.
Individual provider Active NPI Family Medicine Physician · Black River Falls, WI
NPI 1932129665 · NPPES record last updated Jun 30, 2025
Key facts
- NPI
- 1932129665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 47711 (WI)
- Practice address
- 610 W Adams St
Black River Falls, WI 54615-9010 - Phone
- (715) 284-4311
- Fax
- (715) 284-2568
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Saint Louis University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Black River Health Inc
Practice addresses (Care Compare)
711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361
711 W Adams St
Black River Falls, WI 54615-9108
724 Rose St
Black River Falls, WI 54615-9278
Hospital & facility affiliations
- Interim Healthcare of Western Wisconsin
- St Croix Hospice Eau Claire
- Black River Memorial Hospital
- Meadowbrook at Black River Falls
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.18 of 100
- Quality
- 87.29
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 65.34
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, CO
- 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 |
|---|---|---|---|---|
| I20051012000115 | WI | Practitioner - Family Practice |
9032134739 | Reassigns benefits to 3 organizations |
| I20220118000945 | CO | Practitioner - Family Practice | 9032134739 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47711 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Krohn Clinic LTD. | Family Medicine | Current |
Accepting new patients |
| Optumcare Colorado Medical Group LLC | Current |
Accepting new patients | |
| Black River Health Inc | Current |
Accepting new patients | |
| Optumcare Colorado Medical Group LLC | Current |
Accepting new patients | |
| Black River Health Inc | Current |
Accepting new patients | |
| Black River Health Inc | Current | Accepting new patients |
Locations
1625 Medical Center Pt
Ste 290
Colorado Springs, CO 80907
Phone (719) 635-5148
2 S Cascade Ave
Ste 140
Colorado Springs, CO 80903
Phone (719) 538-2900
15909 Jackson Creek Pkwy
Monument, CO 80132
Phone (719) 481-0899
610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311
711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302
Interoperability endpoints
- kevin.anderson@kcld.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/BHJBDA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 47711 | WI | Yes |
Addresses
Primary practice location
610 W Adams St
Black River Falls, WI 54615-9010
Mailing address
610 W Adams St
Black River Falls, WI 54615-9010
Phone (715) 284-4311
Other practice location 1
711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34646600 | Medicaid | WI |
Other providers in Black River Falls, WI
- Advanced Chiropractic and Laser Centers, Inc
- Advanced Chiropractic Clinics Inc
- Advanced Mobility LLC
- Autumn L Alekna
- Rebecca L Amberg
- Rebecca H Anderson
- Jeremy S Anger
- Darrin Antonelli
- Stacy L. Armitage
- Art of Optometry LTD
All providers in Black River Falls, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2025. 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.