NPIMap

Individual provider Active NPI

Jon Adam Kimball, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Los Angeles, CA
National Provider Identifier
1053720565
Registry record updated Jun 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
A139792 Issued in CA
Practice address
1520 San Pablo St Ste 2000
Los Angeles, CA 90033-5322
Phone
(323) 442-5860
NPI assigned
Aug 8, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 11723472-1205 UT
Orthopaedic Surgery of the Spine Physician 207XS0117X A139792 CA Primary

Addresses

Primary practice location

1520 San Pablo St Ste 2000
Los Angeles, CA 90033-5322

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5860

Other practice location 1

1055 N 300 W Ste 400
Provo, UT 84604-3359
Phone (801) 655-4117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200629003542 UT Practitioner - Orthopedic Surgery 3678809407 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of California, Geffen School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Utah Neurological Clinic PCGroup PAC ID 3375575582, 3 clinicians

Practice addresses (Care Compare)

1055 N 300
Suite 400
Provo, UT 84604-3359
Phone (801) 357-7404

Hospital & facility affiliations

  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023
  • Uintah Basin Medical Center Hospital, Roosevelt, UT, CCN 460019
  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047
  • Orem Community Hospital Hospital, Orem, UT, CCN 460043

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion224
Laminectomy or laminotomy (partial removal of spine bones)35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A139792CAMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Neurological Clinic, PC Orthopaedic Surgery of the Spine CurrentSince Jul 1, 2020 Accepting new patients
Utah Neurological Clinic, PC Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Dec 9, 2020 Accepting new patients
Ihc Health Services Inc CurrentSince Dec 9, 2020 Accepting new patients
Ihc Health Services Inc Current Accepting new patients

Locations

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

1055 N 300 W
Ste 400
Provo, UT 84604
Phone (801) 357-7404

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

Interoperability endpoints

  • Direct secure messaging: jon.kimball.1@29327.direct.athenahealth.com

Organizations & group practices 5

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 9

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": "1407456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592524800000",
    "number": "1053720565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 2000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335322",
            "telephone_number": "323-442-5860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 N 300 W Ste 400",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043359",
            "country_code": "US",
            "telephone_number": "801-655-4117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "JON",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-08",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "UT",
            "license": "11723472-1205",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CA",
            "license": "A139792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.