Kellie Goedken Den Hartog, PA-C
Individual provider Active NPI Family Medicine Physician · Rock Rapids, IA
NPI 1992261002 · NPPES record last updated Feb 28, 2019
Key facts
- NPI
- 1992261002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 095185 (IA)
- Practice address
- 1100 S 10TH Ave
Rock Rapids, IA 51246-2020 - Phone
- (712) 472-5399
- NPI assigned
- Feb 13, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 26
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avera McKennan
Sanford Health Network
Practice addresses (Care Compare)
1100 S 10TH Ave
Rock Rapids, IA 51246-2020
1200 1St Ave E
Spencer, IA 51301-4342
Hospital & facility affiliations
- Avera @ Home
- Avera Merrill Pioneer Hospital
- Avera McKennan Hospital & University Health Center
- Avera Merrill Pioneer Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190508002001 | IA | Practitioner - Physician Assistant | 4082956222 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 095185 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera McKennan | Current |
Accepting new patients | |
| Avera McKennan | Current |
Accepting new patients | |
| Avera McKennan | Current |
Accepting new patients | |
| Avera McKennan | Family Medicine | Past | Accepting new patients |
Locations
1100 S 10th Ave
Rock Rapids, IA 51246
Phone (712) 472-5300
1100 S 10th Ave
Ste 100
Rock Rapids, IA 51246
Phone (712) 472-5300
1200 1st Ave E
Spencer, IA 51301
Phone (712) 264-6164
Interoperability endpoints
- kellie.den.hartog@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 095185 | IA | Yes |
Addresses
Primary practice location
1100 S 10TH Ave
Rock Rapids, IA 51246-2020
Mailing address
1363 Highway 9 Apt 5
Larchwood, IA 51241-7585
Phone (712) 348-3341
Other practice location 1
800 S. Green Street
Rock Rapids, IA 51246
Phone (402) 657-0664
Other names
- Kellie Ann Goedken
Other providers in Rock Rapids, IA
- Central Lyon
- Wendee Lee Chase
- Brandon Church
- County of Lyon
- Chester Penn De Jong
- Paulette Deweerd
- Lisa Doorenbos
- Myhre D Dorman
- Noah A Fagerlund
- Susan M Haggar
All providers in Rock Rapids, IA · Family Medicine Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2019. 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.
- 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.