Kelly J. Goeb, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40702 Issued in MN

Practice address

5565 Highway 210
Cromwell, MN 55726-8171

Phone

(320) 245-2250

Fax

(320) 245-2555

NPI assigned

May 27, 2005

Last updated

Jun 21, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: kelly.goeb.1@13291.direct.athenahealth.com

All facility ownership & control disclosures 3

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

Owned or controlled facilities with NPI records 3

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

• St Croix Hospice LLC

  dba St Croix Hospice

  • Community Based Hospice Care Agency
  • Grand Rapids, MN
  • NPI 1770142762

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership
• STCH Moose Lake Opco LLC

  dba St Croix Hospice

  • Community Based Hospice Care Agency
  • Moose Lake, MN
  • NPI 1982463139

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership
• STCH St Cloud LLC

  dba St Croix Hospice

  • Community Based Hospice Care Agency
  • Saint Cloud, MN
  • NPI 1689368144

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

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.

• Moose Lake Community Hospital District

  dba Mercy Hospital

  • Critical Access Hospital
  • Moose Lake, MN
  • NPI 1942398029
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498003200000",
    "number": "1992708564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "557260116",
            "telephone_number": "320-245-2250",
            "fax_number": "320-245-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 HIGHWAY 210",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "557268171",
            "telephone_number": "320-245-2250",
            "fax_number": "320-245-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEB",
        "first_name": "KELLY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-27",
        "last_updated": "2017-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "40702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "695715300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan W. Benzie, M.D.
• Shawn F Bode, MD
• Cromwell Medical Clinic PLLC
• Cromwell Wright Area Fire District
• Gateway Family Health Clinic, LTD.
• Marcia Lillian Pocernich, PT
• Villa Court LLC (Cardinal Court and Villa Vista)
• Villa Court LLC (Villa Vista Care Center)
• Villa Home Care LLC
• Villa Vista, Inc.

• Family Medicine Physician in Cromwell, MN
• Providers in Cromwell, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.