Individual provider Active NPI

Kimberly Nathalia Rogers, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1073809828
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD464812 Issued in PA
Practice address
5675 N Front St Ste 141
Philadelphia, PA 19120-2719
Phone
(267) 428-6575
NPI assigned
Jun 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101255463 VA
Internal Medicine Physician 207R00000X MT300352 PA
Internal Medicine Physician 207R00000X MD464812 PA Primary

Addresses

Primary practice location

5675 N Front St Ste 141
Philadelphia, PA 19120-2719

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (267) 428-6575

Other practice location 1

6431 Sackett St
Philadelphia, PA 19149
Phone (267) 448-4908

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Apr 1, 2023 through Apr 1, 2027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD464812PAMDInternal Medicine Physician
MT300352PAMDInternal Medicine Physician
0101255463VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PMR Virginia Holding, LLC CurrentSince Apr 1, 2021 Accepting new patients
Dedicated Pennsylvania Holding, LLC Internal Medicine Past Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

524 Southpark Blvd
Colonial Hgts, VA 23834
Phone (804) 504-7980

3806 Mechanicsville Tpke
Richmond, VA 23223
Phone (804) 228-1143

6550 Hull St Rd
Richmond, VA 23224
Phone (804) 674-3425

1712 E Broad St
Richmond, VA 23223
Phone (804) 344-9848

Organizations & group practices 2

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": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1073809828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "267-428-6575",
            "fax_number": "305-468-6269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5675 N FRONT ST STE 141",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202719",
            "telephone_number": "267-428-6575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6431 Sackett St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19149",
            "country_code": "US",
            "telephone_number": "267-448-4908",
            "fax_number": "305-698-6536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "KIMBERLY",
        "middle_name": "NATHALIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-21",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101255463",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT300352",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD464812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.