Sandra L Kimball, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN.CNP.07739 Issued in OH

Practice address

415 Byers Rd
Suite 300
Miamisburg, OH 45342

Phone

(937) 866-2494

Fax

(937) 866-8494

NPI assigned

Jul 13, 2005

Reactivated

Nov 30, 2006

Last updated

Aug 27, 2024By 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 2

Addresses

Other identifiers 1

Electronic endpoints 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alliance Physicians Inc

  dba Kettering Health Medical Group

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572

  Adult Health

  Medicare reassignment Care Compare group NPD
• Alliance Physicians Inc

  dba Kettering Health Urgent Care

  • Urgent Care Clinic/Center
  • Beavercreek, OH
  • NPI 1639582182
  NPD

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1033117932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 BYERS RD STE 300",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423684",
            "telephone_number": "937-866-2494",
            "fax_number": "937-866-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 BYERS RD",
            "address_2": "SUITE 300",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "45342",
            "telephone_number": "937-866-2494",
            "fax_number": "937-866-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "SANDRA",
        "middle_name": "L",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "deactivation_date": "2006-06-08",
        "reactivation_date": "2006-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "NP07739",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.07739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2504927",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "415 Byers Rd",
            "address_2": "Suite 300",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45342",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skimballmurnen10712@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "415 Byers Rd",
            "address_2": "Suite 300",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kettering Rehabilitation, Inc
• Camyrn Key-Mahn, RBT
• Farzam Saleem Khokhar
• Jason Kibby
• Seth T Kidwell, MSN, FNP-BC
• Andrea Marie Kimmel
• Amy Marie King
• Maurine Muthoni Kingori
• Kingston of Miamisburg, LLC (Kingston Of Miamisburg)
• Linda Lou Kintz, MD

• Adult Health Nurse Practitioner in Miamisburg, OH
• Providers in Miamisburg, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.