Individual provider Active NPI

Ryan Kimball

  • Family Nurse Practitioner
  • Elkton, MD
National Provider Identifier
1053721233
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AC001389 Issued in MD
Practice address
111 W High St
Suite 314
Elkton, MD 21921-5529
Phone
(410) 620-0545
NPI assigned
Apr 28, 2014
Last updated
Sep 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AC001389 MD Primary

Addresses

Primary practice location

111 W High St
Suite 314
Elkton, MD 21921-5529

Mailing address

210 Chesapeake Blvd
Elkton, MD 21921-6395

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20141010002103 MD Practitioner - Nurse Practitioner 5890915995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Union Hospital of Cecil CountyGroup PAC ID 6901719822, 281 clinicians

Practice addresses (Care Compare)

106 Bow St
Elkton, MD 21921-5544
Phone (410) 398-4000

111 W High St
Union Primary Care of Elkton Suite 314
Elkton, MD 21921-8617
Phone (410) 620-0545

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.57 of 100Reported as group
Quality
59.34
Promoting interoperability
89
Improvement activities
40
Cost
75.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Union Hospital of Cecil County CurrentSince Sep 10, 2014 Accepting new patients
Union Hospital of Cecil County CurrentSince Sep 10, 2014 Accepting new patients
Union Hospital of Cecil County Past Accepting new patients

Locations

106 Bow St
Elkton, MD 21921
Phone (410) 298-2000

106 Bow St
Ofc
Elkton, MD 21921

111 W High St
Ste 314
Elkton, MD 21921
Phone (410) 398-4510

210 Chesapeake Blvd
Elkton, MD 21921

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

Hospital & facility affiliations 7

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": "1398643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1053721233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CHESAPEAKE BLVD",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219216395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W HIGH ST",
            "address_2": "SUITE 314",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215529",
            "telephone_number": "410-620-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-28",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC001389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

Verify at the official NPI Registry.