NPIMap

Individual provider Active NPI

Kynan Charles Trail, MD

  • Surgery Physician
  • Yankton, SD
National Provider Identifier
1962452458
Registry record updated Jul 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4733 Issued in SD
Practice address
2525 Fox Run Pkwy
Suite 204
Yankton, SD 57078-5370
Phone
(605) 668-9670
Fax
(605) 668-0371
NPI assigned
May 12, 2006
Last updated
Jul 19, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4733 SD Primary

Addresses

Primary practice location

2525 Fox Run Pkwy
Suite 204
Yankton, SD 57078-5370

Mailing address

2525 Fox Run Pkwy
Suite 204
Yankton, SD 57078-5370
Phone (605) 668-9670

Other identifiers 2

IdentifierTypeStateIssuer
46045455602MedicaidNE
7301750MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, NH, MT, MN4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20111103000495 SD Practitioner - General Surgery 6305749912 Reassigns benefits to 4 organizations
I20201214000255 NH Practitioner - General Surgery 6305749912 Reassigns benefits to 3 organizations
I20210107002779 MT Practitioner - General Surgery 6305749912 Reassigns benefits to 1 organization
I20210729001679 MN Practitioner - General Surgery 6305749912 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Range Regional Health ServicesGroup PAC ID 8022920024, 349 clinicians
Androscoggin Valley Hospital IncGroup PAC ID 2365350725, shared by 3 NPIs, 61 clinicians
Winona Health ServicesGroup PAC ID 8527977420, 160 clinicians

Practice addresses (Care Compare)

3605 Mayfair Ave
Hibbing, MN 55746-2935
Phone (218) 262-3441

59 Page Hill Rd
Berlin, NH 03570-3531
Phone (603) 752-2200

855 Mankato Ave
Winona, MN 55987-4868
Phone (507) 454-3650

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux14
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4733SDMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas County Memorial Hospital CurrentSince Feb 15, 2020 Accepting new patients
St. Benedict Health Center CurrentSince May 1, 2020 Accepting new patients
Douglas County Memorial Hospital CurrentSince Feb 15, 2020 Accepting new patients
St Benedict Health Center CurrentSince May 1, 2020 Accepting new patients
Winona Health Services CurrentSince Jul 7, 2021 Accepting new patients
Gabert Medical Services, Inc CurrentSince Feb 19, 2021 Accepting new patients
Range Regional Health Services CurrentSince Jul 1, 2021 Accepting new patients
St Benedict Health Center Current Accepting new patients
Douglas County Memorial Hospital Current Accepting new patients
Range Regional Health Services Current Accepting new patients
Range Regional Health Services CurrentSince Jul 1, 2021 Accepting new patients
Douglas County Memorial Hospital Past Accepting new patients

Locations

1814 14th Ave E
Hibbing, MN 55746
Phone (218) 262-3441

3605 Mayfair Ave
Hibbing, MN 55746
Phone (218) 262-3441

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

855 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

107 Dilworth St
Glendive, MT 59330
Phone (406) 345-8900

708 8th St
Armour, SD 57313
Phone (605) 724-2159

401 W Glynn Dr
Parkston, SD 57366
Phone (605) 928-3311

Interoperability endpoints

  • Direct secure messaging: ktrail673206@fairview.direct-ci.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 12

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1962452458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 FOX RUN PKWY",
            "address_2": "SUITE 204",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570785370",
            "telephone_number": "605-668-9670",
            "fax_number": "605-668-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 FOX RUN PKWY",
            "address_2": "SUITE 204",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570785370",
            "telephone_number": "605-668-9670",
            "fax_number": "605-668-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAIL",
        "first_name": "KYNAN",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SD",
            "license": "4733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46045455602",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7301750",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yankton, SD

Sources for this page

Verify at the official NPI Registry.