DR. KEVIN A KARLS M.D.
NPI 1790762086
Internal Medicine - Gastroenterology in Bismarck, ND

NPI Status: Active since December 28, 2005

Contact Information

310 N 10TH ST
BISMARCK, ND
ZIP 58501
Phone: (701) 877-2020

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 22
Internal Medicine
Gastroenterology
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About KEVIN KARLS

This page provides the complete NPI Profile along with additional information for Kevin Karls, an internist established in Bismarck, North Dakota with a medical specialization in Internal Medicine, focusing in gastroenterology and more than 22 years of experience. He graduated from University Of North Dakota School Of Medicine in 2004. The healthcare provider is registered in the NPI registry with number 1790762086 assigned on December 2005. The practitioner's primary taxonomy code is 207RG0100X with license number 11561 (ND). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI: 1790762086
Provider Name: DR. KEVIN A KARLS M.D.
Gender: Male
Entity Type: Individual
Location Address: 310 N 10TH ST BISMARCK, ND 58501
Location Phone: (701) 877-2020
Mailing Address: 310 N 10TH ST BISMARCK, ND 58501
Mailing Phone: (701) 877-2020
Medical School Name: UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE
Graduation Year: 2004
Is Sole Proprietor?: No
Enumeration Date: 12-28-2005
Last Update Date: 03-08-2022
Code Navigator

An internist like Kevin Karls is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Internal Medicine Gastroenterology
Taxonomy Code: 207RG0100X
Type: Allopathic & Osteopathic Physicians
License No.: 11561
License State: ND
Taxonomy Description: An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine	47691 (MN)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Blue Cross Blue Shield of North Dakota

BlueCare Bronze HSA Eligible $50 PCP Copay ($5 Value Based Drug List) - PPO
BlueCare Gold $10 PCP Copay ($5 Value Based Drug List) - PPO
BlueCare Silver $20 PCP Copay ($5 Value Based Drug List) - PPO
BlueDirect Bronze 100 HSA Eligible ($8000 Deductible / $5 Preventive Drug List) - PPO
BlueDirect Gold 90 HSA Eligible ($2600 Deductible / $5 Preventive Drug List) - PPO
BlueDirect Silver 80 HSA Eligible ($3500 Deductible / $5 Preventive Drug List) - PPO
BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible - PPO
BlueValue Bronze HSA Eligible $50 PCP Copay (Standardized plan) - PPO
BlueValue Gold $30 PCP Copay (Standardized plan) - PPO
BlueValue Silver $40 PCP Copay (Standardized plan) - PPO
DakotaBlue Altru Gold ($5 Value Based Drug List) - PPO
DakotaBlue Altru Silver ($5 Value Based Drug List) - PPO
DakotaBlue Trinity Gold ($5 Value Based Drug List) - PPO
DakotaBlue Trinity Silver ($5 Value Based Drug List) - PPO

Medica

Essentia Choice Care with Medica Bronze $0 Copay PCP Visits - HMO
Essentia Choice Care with Medica Bronze Share - HMO
Essentia Choice Care with Medica Expanded Bronze Standard - HMO
Essentia Choice Care with Medica Gold $0 Copay PCP Visits - HMO
Essentia Choice Care with Medica Gold Share - HMO
Essentia Choice Care with Medica Gold Standard - HMO
Essentia Choice Care with Medica Silver $0 Copay PCP Visits - HMO
Essentia Choice Care with Medica Silver Share - HMO
Essentia Choice Care with Medica Silver Standard - HMO
Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
Medica Individual Choice Bronze HSA - EPO
Medica Individual Choice Bronze Share - EPO
Medica Individual Choice Bronze Share - HMO
Medica Individual Choice Expanded Bronze Standard - EPO
Medica Individual Choice Expanded Bronze Standard - HMO
Medica Individual Choice Gold $0 Copay PCP Visits - EPO
Medica Individual Choice Gold $0 Copay PCP Visits - HMO
Medica Individual Choice Gold Share - EPO
Medica Individual Choice Gold Share - HMO
Medica Individual Choice Gold Standard - EPO

Sanford Health Plan

Sanford Individual Simplicity $1,750 - PPO
Sanford Individual Simplicity $10,600 - PPO
Sanford Individual Simplicity $3,500 - PPO
Sanford Individual Simplicity $4,750 - PPO
Sanford Individual Simplicity $6,500 - PPO
Sanford Individual Simplicity $7,200 HSA Qualified - PPO
Sanford Individual Simplicity Standardized $2,000 - PPO
Sanford Individual Simplicity Standardized $6,000 - PPO
Sanford Individual Simplicity Standardized $7,500 - PPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
929642500	MEDICAID (05)	MN

Medicare Participation & PECOS Enrollment Status

Kevin Karls is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Kevin Karls is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 7618900242
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20101011001180
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Biopsy of large bowel using a flexible endoscope
Biopsy of small bowel (except ileum) using an endoscope
Colonoscopy
Colorectal cancer screening; colonoscopy on individual at high risk
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Initial hospital inpatient care per day, typically 50 minutes
Insertion of guide wire with dilation of esophagus using a flexible endoscope
Insertion of needle into vein for collection of blood sample
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
Removal of polyps or growths of large bowel using an endoscope with mechanical snare
Upper gastrointestinal (GI) endoscopy for acid reflux

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.86 for a new patient copayment and $24.57 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 58501 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $127.45
Minimum New Patient Price $55.75
Maximum New Patient Price $168.12

Average New Patient Copayment $31.86
Minimum New Patient Copayment $13.93
Maximum New Patient Copayment $42.03

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $98.29
Minimum Established Patient Price $18.11
Maximum Established Patient Price $137.65

Average Established Patient Copayment $24.57
Minimum Established Patient Copayment $4.52
Maximum Established Patient Copayment $34.41

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Breast Cancer Screening	65%	130
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Chronic Care and Preventative Care Management for Empaneled Patients	Yes	N/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Documentation of Current Medications in the Medical Record	100%	412
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing	96%	1979
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel Level	Yes	N/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Medication Reconciliation	64%	346
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	74%	1308
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Provide Patient Access	96%	1308
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	50%	1308
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Kevin Karls is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
CHI ST ALEXIUS HEALTH	900 E BROADWAY BISMARCK, ND 58501	(701) 530-7000	Acute Care Hospitals
ESSENTIA HEALTH	3000 32ND AVE SOUTH FARGO, ND 58104	(701) 364-8000	Acute Care Hospitals

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1790762086, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 18 → 1 + 8

Pos 4

Unchanged

Pos 5

Doubled → 14 → 1 + 4

Pos 6

Unchanged

Pos 7

Doubled → 4

Pos 8

Unchanged

Pos 9

Doubled → 16 → 1 + 6

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 9 → 18 → 9 7 → 14 → 5 2 → 4 8 → 16 → 7

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 7 + 1 + 8 + 0 + 1 + 4 + 6 + 4 + 0 + 1 + 6 + 24 = 64

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 64 is 70. The difference is the calculated check digit.

70 - 64 = 6

This NPI is valid

The calculated check digit is 6, which matches the last digit of 1790762086.