Kimberly Suzanne Churbock, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

130218 Issued in OH

Practice address

27089 Bagley Rd
Olmsted TWP, OH 44138-1103

Phone

(440) 234-4700

NPI assigned

Apr 1, 2013

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 names 1

• Kimberly Suzanne Soukup Other name

Medicare fee-for-service enrollment

Enrolled in OH

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment NPD

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1023351749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 JOHN AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133281",
            "telephone_number": "330-962-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27089 BAGLEY RD",
            "city": "OLMSTED TWP",
            "state": "OH",
            "postal_code": "441381103",
            "telephone_number": "440-234-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURBOCK",
        "first_name": "KIMBERLY",
        "middle_name": "SUZANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-01",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "130218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SOUKUP",
            "middle_name": "SUZANNE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Katherine Borns
• Thu Thao Bui
• Julio Camargo Jr.
• Anthony Caraballo
• Darleen Marie Caraffi, MA, CCC/SLP
• Edward Arthur Craft II, D.O.
• Melanie N. Crookston, M.A. CCC-SLP
• Dependable Hands Home Health Care LLC
• Marla A. Difilippo
• Melissa Dubravetz

• Pediatrics Physician in Olmsted TWP, OH
• Providers in Olmsted TWP, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.