Individual provider Active NPI

Jerome Martin Kjolsing, DDS

  • Dentist
  • New Richmond, WI
National Provider Identifier
1932203163
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5002198015 Issued in WI
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

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151029001428 WI Order and Referring Only - DentistPractitioner - Dentist 0941519128

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5002198015WIMDDentist

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

Verify at the official NPI Registry.