NPIMap

Individual provider Active NPI

Kimberly Breidenbach, MD

  • Family Medicine Physician
  • Whitehall, WI
National Provider Identifier
1972893071
Registry record updated Feb 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
62657 Issued in WI
Practice address
18606 Ervin St
Whitehall, WI 54773-8613
Phone
(715) 538-4355
NPI assigned
Apr 11, 2011
Last updated
Feb 16, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2015

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 62657 WI Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141210001655 WI Practitioner - Family Practice 9234451832 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-County Memorial Hospital IncGroup PAC ID 4587642418, shared by 5 NPIs, 75 clinicians

Practice addresses (Care Compare)

18601 Lincoln St
Whitehall, WI 54773-8605
Phone (715) 538-4361

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62657WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-County Memorial Hospital, Inc. CurrentSince Oct 13, 2014 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Oct 13, 2014 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

  • Direct secure messaging: kbreidenbach76765@direct.emplifyhealth.org

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gundersen Tri-County Hospital and ClinicsWhitehall, WI, CCN 521316 Hospital Corporate Director Nov 25, 2014
Gundersen Tri-County Hospital and ClinicsWhitehall, WI, CCN 52Z316 Hospital Corporate Director Nov 25, 2014
Gundersen Tri-County Hospital and Clinics-BlairBlair, WI, CCN 528552 Rural health clinic Corporate Director Nov 25, 2014
Emplify HealthMondovi, WI, CCN 528551 Rural health clinic Corporate Director Nov 25, 2014
Gundersen Tri-County Hospital and Clinics- WhitehallWhitehall, WI, CCN 528553 Rural health clinic Corporate Director Nov 25, 2014

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 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": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424044800000",
    "number": "1972893071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18606 ERVIN ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738613",
            "telephone_number": "715-538-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREIDENBACH",
        "first_name": "KIMBERLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2015-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "62657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitehall, WI

Sources for this page

Verify at the official NPI Registry.