Kimberly N Hackney, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2010037113 Issued in MO

Practice address

300 Winding Woods Dr Ste 120
O Fallon, MO 63366-4772

Phone

(636) 978-7902

NPI assigned

Jun 24, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Kimberly N. Robinson Former name

Medicare fee-for-service enrollment

Enrolled in MO

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krobinson394766@directc.mercy.net

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.

• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228

  Pediatrics

  Medicare reassignment NPD
• Mercy Hospitals East Communities

  • Clinic/Center
  • Saint Louis, MO
  • NPI 1851431738
  Medicare reassignment
• Tiger Pediatrics LLC

  • Pediatrics Physician
  • Columbia, MO
  • NPI 1871872770
  NPD (past)

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1083842454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WINDING WOODS DR STE 120",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633664772",
            "telephone_number": "636-978-7902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WINDING WOODS DR STE 120",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633664772",
            "telephone_number": "636-978-7902"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 S New Ballas Rd",
            "address_2": "Suite 6006B",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418221",
            "country_code": "US",
            "telephone_number": "314-251-6299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HACKNEY",
        "first_name": "KIMBERLY",
        "middle_name": "N",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-24",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MO",
            "license": "2010037113",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "KS",
            "license": "05-35901",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2010037113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01296531",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS MEDICAL ASSISTANCE PROGRAM",
            "identifier": "PAYEE 1",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083842454",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ROBINSON",
            "middle_name": "N.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Francis Grosch
• Danielle Suzanne Grunloh-Gumpenberger, MD
• Brian A Grus, MD
• Jack Guo
• Sandra M Habermaas-Herold, CRNA
• Emily Hadsall, DC
• Kaitlyn Hagee
• Benjamin G Hagen, MPT
• Janice E Hager-Klein, L.P.C.
• Lauren Hall, MOT/L

• Pediatrics Physician in O Fallon, MO
• Providers in O Fallon, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.