Charles H Klos, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Whitehall, Wisconsin. His current practice location is
18601 Lincoln St, Whitehall, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(715) 538-4361.
Charles H Klos is licensed to practice in Wisconsin (license number 82758-030) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1710906813.
Provider's Profile
| Full Name | Charles H Klos |
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| Gender | Male |
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| Speciality | Nurse Anesthetist, Certified Registered |
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| Location | 18601 Lincoln St, Whitehall, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1710906813
- Provider Enumeration Date: 07/19/2006
- Last Update Date: 05/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 3678732500
- Enrollment ID: I20120312000673
Medical Identifiers
Medical identifiers for Charles H Klos such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1710906813 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 367500000X | Nurse Anesthetist, Certified Registered | 82758-030 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Charles H Klos allows following entities to bill medicare on his behalf.
| Entity Name | Black River Health Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1811940331
PECOS PAC ID: 3173431178
Enrollment ID: O20040303000688 |
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| Entity Name | Tri-county Memorial Hospital Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1417201864
PECOS PAC ID: 4587642418
Enrollment ID: O20040708000696 |
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| Entity Name | Midwest Anesthesia Care Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1740988542
PECOS PAC ID: 2567817042
Enrollment ID: O20231018003936 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Charles H Klos is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Charles H Klos, CRNA
18601 Lincoln St,
Whitehall, WI 54773-8605
Ph: (715) 538-4361 | Charles H Klos, CRNA
18601 Lincoln St,
Whitehall, WI 54773-8605
Ph: (715) 538-4361 |
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