Individual provider Active NPI

Kimberly Ruth Thomas, NP

  • Family Nurse Practitioner
  • Pico Rivera, CA
National Provider Identifier
1063812303
Registry record updated Sep 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95001754 Issued in CA
Practice address
9436 Slauson Ave
Pico Rivera, CA 90660-4748
Phone
(626) 919-4333
NPI assigned
Aug 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 838492 CA
Family Nurse Practitioner 363LF0000X 95001754 CA Primary

Addresses

Primary practice location

9436 Slauson Ave
Pico Rivera, CA 90660-4748

Mailing address

9436 Slauson Ave
Pico Rivera, CA 90660-4748

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20150625002363 CA Practitioner - Nurse Practitioner 1355652710 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
838492CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Community Health Center, Inc. CurrentSince Apr 14, 2015 Accepting new patients
East Valley Community Health Center, Inc. Current Accepting new patients
Goldencast Medical Corporation PastSince May 1, 2008 Accepting new patients

Locations

1555 S Garey Ave
Pomona, CA 91766
Phone (909) 620-8088

420 S Glendora Ave
West Covina, CA 91790
Phone (626) 919-5724

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.

NPI Registry JSON

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442880000000",
    "number": "1063812303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9436 SLAUSON AVE",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9436 SLAUSON AVE",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604748",
            "telephone_number": "626-919-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "KIMBERLY",
        "middle_name": "RUTH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-22",
        "last_updated": "2015-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "838492",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95001754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pico Rivera, CA

Sources for this page

Verify at the official NPI Registry.