Kimberly W Reisenauer, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

638 Issued in SC

Practice address

325 Broad St
Suite 100
Sumter, SC 29150-4167

Phone

(803) 773-5227

Fax

(803) 774-5400

NPI assigned

Mar 8, 2007

Last updated

Feb 1, 2012By 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

Other names 1

• Ms. Kimberly S Weiss Former name

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Medical University of South Carolina College of Medicine, 2000

Medicare assignment

May accept Medicare assignment

Group practices

Colonial Family Practice LLCGroup PAC ID 9931017118, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prisma Health Tuomey Hospital Hospital, Sumter, SC, CCN 420070

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CIHIBD
• Direct secure messaging: kimberly.reisenauer@colonialhealthcare.eclinicaldirectplus.com

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.

• Colonial Family Practice, LLC

  dba Colonial Family Practice

  • Family Medicine Physician
  • Sumter, SC
  • NPI 1518074640

  Physician Assistant

  Medicare reassignment Care Compare group NPD (past)
• Colonial Family Practice, LLC

  dba Colonial Family Practice Liberty Street Location

  • Family Medicine Physician
  • Sumter, SC
  • NPI 1225687338

  Physician Assistant

  NPD
• Colonial Family Practice - Manning

  • Family Medicine Physician
  • Manning, SC
  • NPI 1689006652

  Physician Assistant

  NPD (past)
• Colonial Family Practice & Ambulatory Care Center

  dba Colonial Family Practice Columbia

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1902229214

  Physician Assistant

  NPD (past)
• Colonial Family Practice, LLC

  dba Colonial Family Practice Camden Location

  • Family Medicine Physician
  • Camden, SC
  • NPI 1033402599

  Physician Assistant

  NPD (past)
• Colonial Family Practice, LLC

  dba Santee Cooper Urgent Care

  • Family Medicine Physician
  • Manning, SC
  • NPI 1467999326
  NPD (past)
• Colonial Family Practice, LLC

  dba Colonial Family Practice Wesmark

  • Family Medicine Physician
  • Sumter, SC
  • NPI 1497060719
  NPD (past)
• Colonial Family Practice, LLC

  dba Primary Care at Santee Cooper

  • Family Medicine Physician
  • Manning, SC
  • NPI 1508302308
  NPD (past)
• Colonial Family Practice, LLC

  dba Colonial Pain Management

  • Sports Medicine (Family Medicine) Physician
  • Sumter, SC
  • NPI 1831435429
  NPD (past)
• Colonial Family Practice, LLC

  dba Colonial Pediatrics

  • Pediatrics Physician
  • Sumter, SC
  • NPI 1851547640
  NPD (past)
• Colonial Family Practice, LLC

  dba Colonial Urgent Care

  • Emergency Medicine Physician
  • Sumter, SC
  • NPI 1912541814

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prisma Health-Midlands

  dba Prisma Health Tuomey Hosptial

  • General Acute Care Hospital
  • Sumter, SC
  • NPI 1326043548
  Care Compare affiliation

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1023149101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 BROAD ST",
            "address_2": "SUITE 100",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504167",
            "telephone_number": "803-773-5227",
            "fax_number": "803-774-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 BROAD ST",
            "address_2": "SUITE 100",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504167",
            "telephone_number": "803-773-5227",
            "fax_number": "803-774-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISENAUER",
        "first_name": "KIMBERLY",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0109PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WEISS",
            "middle_name": "S",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Brittany Sue Rees, DPT
• Cynthia Skelton Reese, M.D.
• Allison Antoinette Reeves, DMD
• Sara Elizabeth Clyburn Reid, PHARMD
• Jordan Thomas Reizer I, DC
• Reliable Medical Equipment of South Carolina, LLC
• Renewed Image Youth & Family Services, LLC
• Restorative Arts Dental PA
• Restorative Arts Dental PA

• Physician Assistant in Sumter, SC
• Providers in Sumter, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.