Kerilyn Woodbridge Kimball

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

20A16745 Issued in CA

Practice address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111

Phone

(860) 716-7630

NPI assigned

Mar 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Emergency Medicine

Education

Edward Via Col of Osteo Medicine-Virginia Campus, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Catawba Valley Medical Center Hospital, Hickory, NC, CCN 340143

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment Care Compare group NPD

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

• Catawba Valley Medical Center

  • General Acute Care Hospital
  • Hickory, NC
  • NPI 1164495255
  Care Compare affiliation

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1023559283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "860-716-7630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "KERILYN",
        "middle_name": "WOODBRIDGE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-20",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "CA",
            "license": "20A16745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Kim, DPM
• Min H Kim
• Peter S Kim, DO
• Sun Kuk Kim, PA-C
• Sung Yong Kim, M.D
• Timothy Kimball
• Azia King, MA
• Michael Charles King, D.O.
• Nell Fearing King
• Renee King, PA-C

• Military Health Care Provider in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Military Health Care Provider in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.
• 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.