Active NPI
Jerome Martin Kjolsing, DDS
- Dentist
- New Richmond, WI
National Provider Identifier
1932203163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5002198015
- Practice address
- 645 Hospital Road
New Richmond, WI 54017 - Phone
- (715) 246-2555
- Fax
- (715) 246-4361
- NPI assigned
- Sep 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5002198015 | WI | Primary |
Addresses
Primary practice location
645 Hospital Road
New Richmond, WI 54017
Mailing address
645 Hospital Road
New Richmond, WI 54017
Phone (715) 246-2555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151029001428 | WI | Order and Referring Only - Dentist | 0941519128 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5002198015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932203163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 HOSPITAL ROAD",
"city": "NEW RICHMOND",
"state": "WI",
"postal_code": "54017",
"telephone_number": "715-246-2555",
"fax_number": "715-246-4361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 HOSPITAL ROAD",
"city": "NEW RICHMOND",
"state": "WI",
"postal_code": "54017",
"telephone_number": "715-246-2555",
"fax_number": "715-246-4361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KJOLSING",
"first_name": "JEROME",
"middle_name": "MARTIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5002198015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New Richmond, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.