NPIMap

Individual provider Active NPI

John Kimball, PA-C

  • Physician Assistant
  • Henderson, NC
National Provider Identifier
1083382634
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
381 Ruin Creek Rd
Henderson, NC 27536-2932
Phone
(252) 430-0666
NPI assigned
Aug 31, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

381 Ruin Creek Rd
Henderson, NC 27536-2932

Mailing address

819 Silver Linden LN
Wake Forest, NC 27587-2958

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20211025001086 NC Practitioner - Physician Assistant 0042608036 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Duke University Health System, IncGroup PAC ID 2567372345, 1,083 clinicians

Practice addresses (Care Compare)

3400 Wake Forest Rd
Raleigh, NC 27609-7317
Phone (919) 954-3965

3404 Wake Forest Rd
Raleigh, NC 27609-7340
Phone (919) 862-5400

3643 N Roxboro Rd
Durham, NC 27704-2702
Phone (919) 470-8490

3643 N Roxboro St
Durham, NC 27704-2702
Phone (919) 470-5356

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Dec 2, 2022 Accepting new patients
Duke University Health System, Inc. Family Medicine Current Accepting new patients
Duke University Health System, Inc. Family Medicine CurrentSince Dec 2, 2022 Accepting new patients

Locations

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

3400 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 954-3000

Interoperability endpoints

  • Direct secure messaging: jkimball462304@direct.medicine.duke.edu

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, 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": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1083382634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 SILVER LINDEN LN",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275872958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362932",
            "telephone_number": "252-430-0666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NC

Sources for this page

Verify at the official NPI Registry.