Kimberly B. Fogarty, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110001588 Issued in VA

Practice address

2440 M St NW
Suite 205
Washington, DC 20037-1404

Phone

(202) 955-0003

Fax

(866) 457-0397

NPI assigned

Oct 3, 2006

Last updated

Mar 7, 2023By 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: healingriverintegrativemedicine.kimberlyfogarty@161554.advancedmd-direct.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.

• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Virginia Integrative Psychiatry, PC

  • Psychiatry Physician
  • Fredericksburg, VA
  • NPI 1992256135
  NPD (past)
• Windber Hospital, Inc.

  dba Windber Medical Center

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1053405027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 M ST NW",
            "address_2": "SUITE 205",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200371404",
            "telephone_number": "202-955-0003",
            "fax_number": "866-457-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 M ST NW",
            "address_2": "SUITE 205",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200371404",
            "telephone_number": "202-955-0003",
            "fax_number": "866-457-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGARTY",
        "first_name": "KIMBERLY",
        "middle_name": "B.",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110001588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "145453",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0110001588",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA030663",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sulaiman Home Support Fofanah
• Justine Fofou
• Theresia Dimia Fofung, RN
• Zacharia Fogam, HOME HEALTH AIDE
• Devine Fogang
• Diane Fogg, PEER SUPPORT SPEC.
• Davon Foggo-Adams, NP
• Foggy Bottom Dental
• Foggy Bottom Physician Group Inc.
• Foggy Bottom Physician Group Inc.

• Medical Physician Assistant in Washington, DC
• Providers in Washington, DC by specialty
• Medical Physician Assistant in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.