Kimberly Breidenbach, MD
Individual provider Active NPI Family Medicine Physician · Whitehall, WI
NPI 1972893071 · NPPES record last updated Feb 16, 2015
Key facts
- NPI
- 1972893071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 62657 (WI)
- Practice address
- 18606 Ervin St
Whitehall, WI 54773-8613 - Phone
- (715) 538-4355
- NPI assigned
- Apr 11, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 12
Owned or controlled facilities with NPI records 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tri-County Memorial Hospital Inc
Practice addresses (Care Compare)
18601 Lincoln St
Whitehall, WI 54773-8605
Phone (715) 538-4361
Hospital & facility affiliations
- St Croix Hospice Eau Claire
- Gundersen Tri-County Hospital & Clinics
- Gundersen Lutheran Medical Center
- Mayo Clinic Health System Eau Claire Hospital
- Gundersen Tri-County Hospital & Clinics
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Gundersen Tri-County Hospital and Clinics |
Hospital | Corporate Director | Nov 25, 2014 |
| Gundersen Tri-County Hospital and Clinics |
Hospital | Corporate Director | Nov 25, 2014 |
| Gundersen Tri-County Hospital and Clinics-Blair |
Rural health clinic | Corporate Director | Nov 25, 2014 |
| Emplify Health |
Rural health clinic | Corporate Director | Nov 25, 2014 |
| Gundersen Tri-County Hospital and Clinics- Whitehall |
Rural health clinic | Corporate Director | Nov 25, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141210001655 | WI | Practitioner - Family Practice | 9234451832 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62657 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-County Memorial Hospital, Inc. | Current | Accepting new patients | |
| Tri-County Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Tri-County Memorial Hospital, Inc. | Current |
Accepting new patients |
Locations
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712
18606 Ervin St
Whitehall, WI 54773
Phone (715) 538-4330
Interoperability endpoints
- kbreidenbach76765@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 62657 | WI | Yes |
Addresses
Primary practice location
18606 Ervin St
Whitehall, WI 54773-8613
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other providers in Whitehall, WI
- Kari Marie Baumel
- Kristine Benusa
- Nicole Lestencia Bjerke
- Kathy Ann Boe
- Briana M Braunschweig
- Lisa Brooks
- Robert Burge
- Curtis C Carlson
- Loren Ray Carrell
- Jane Comstock
All providers in Whitehall, 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 Feb 16, 2015. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.