Individual provider Active NPI

Kim Rita Blumberg, MD

  • Anesthesiology Physician
  • Charlotte, NC
National Provider Identifier
1053380964
Registry record updated Mar 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2010-01959 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 749-5800
Fax
(704) 749-5819
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 01058708A IN
Anesthesiology Physician 207L00000X 2010-01959 NC Primary

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

200 Providence Rd
Ste. 101
Charlotte, NC 28207-1468
Phone (704) 749-5800

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110606000000 NC Practitioner - Anesthesiology 3870647282 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Texas Medical Branch at Galveston, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Anesthesiology Associates PAGroup PAC ID 3971566761, 218 clinicians
Gate City Anesthesia, IncGroup PAC ID 8820089329, 19 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-4000

705 Green Valley Rd
Greensboro, NC 27408-7019
Phone (336) 272-5001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01058708AINMDAnesthesiology Physician
2010-01959NCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince May 1, 2012 Accepting new patients
Carolina Anesthesia Associates PA Anesthesiology PastSince Oct 3, 2000 Accepting new patients

Locations

200 Providence Rd
Ste 101
Charlotte, NC 28207

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1053380964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PROVIDENCE RD",
            "address_2": "STE. 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071468",
            "telephone_number": "704-749-5800",
            "fax_number": "704-749-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-749-5800",
            "fax_number": "704-749-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMBERG",
        "first_name": "KIM",
        "middle_name": "RITA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01058708A",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2010-01959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.