Individual provider Active NPI

Kevin M Anderson, M.D.

  • Family Medicine Physician
  • Black River Falls, WI
National Provider Identifier
1932129665
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
47711 Issued in 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
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 47711 WI Primary

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 1

IdentifierTypeStateIssuer
34646600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, CO2 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

Enrollment IDStateProvider typePAC IDDetails
I20051012000115 WI Practitioner - Family PracticePractitioner - Obstetrics/GynecologyPractitioner - Hospice/Palliative Care 9032134739 Reassigns benefits to 3 organizations
I20220118000945 CO Practitioner - Family Practice 9032134739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospice/Palliative Care
Education
Saint Louis University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Black River Health IncGroup PAC ID 3173431178, 62 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
89.18 of 100Reported as group
Quality
87.29
Promoting interoperability
100
Improvement activities
40
Cost
65.34

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47711WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Black River Health Inc CurrentSince Dec 30, 2024 Accepting new patients
Black River Health Inc CurrentSince Dec 30, 2024 Accepting new patients
Optumcare Colorado Medical Group LLC CurrentSince Jan 31, 2022 Accepting new patients
Krohn Clinic LTD. Family Medicine CurrentSince Oct 1, 2005 Accepting new patients
Black River Health Inc Current Accepting new patients
Optumcare Colorado Medical Group LLC CurrentSince Jan 31, 2022 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) 284-3604

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BHJBDA
  • Direct secure messaging: kevin.anderson@kcld.eclinicaldirectplus.com

Organizations & group practices 6

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1932129665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159010",
            "telephone_number": "715-284-4311",
            "fax_number": "715-284-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159010",
            "telephone_number": "715-284-4311",
            "fax_number": "715-284-2568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 W Adams St",
            "address_purpose": "LOCATION",
            "city": "Black River Falls",
            "state": "WI",
            "postal_code": "546155052",
            "country_code": "US",
            "telephone_number": "715-284-5361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "47711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34646600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

Verify at the official NPI Registry.