Active NPI
Kimberly Nathalia Rogers, M.D.
- Internal Medicine Physician
- Philadelphia, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD464812
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| MD464812 | PA | MD | Internal Medicine Physician |
| MT300352 | PA | MD | Internal Medicine Physician |
| 0101255463 | VA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PMR Virginia Holding, LLC | Current | 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.
-
- Specialist
- Miami Gardens, FL
- NPI 1083167001
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; 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.