Elk River Medical Associates, PA

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

38891 Issued in NC

Legal business name

ELK RIVER MEDICAL ASSOCIATES, PA

Practice address

150 Park Ave
Banner Elk, NC 28604-6604

Phone

(828) 898-5177

Fax

(828) 898-8306

NPI assigned

Sep 13, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Paul Kimmel, MDNPI 1053306092

Title

President/Staff Physician

Phone

(828) 898-5177

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Elk River Internal Medicine Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Paul Kimmel, MD

  • Internal Medicine Physician
  • Banner Elk, NC
  • NPI 1053306092
  Authorized official Same address or phone

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093700338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1568",
            "city": "BANNER ELK",
            "state": "NC",
            "postal_code": "286041568",
            "telephone_number": "828-898-5177",
            "fax_number": "828-898-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PARK AVE",
            "city": "BANNER ELK",
            "state": "NC",
            "postal_code": "286046604",
            "telephone_number": "828-898-5177",
            "fax_number": "828-898-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK RIVER MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIMMEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT/STAFF PHYSICIAN",
        "authorized_official_telephone_number": "828-898-5177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NC",
            "license": "38891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890150B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4404134",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RAILROAD MEDICARE",
            "identifier": "C14617",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BLUECROSS BLUESHIELD",
            "identifier": "0150B",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN BLUECROSS&TENNCARE",
            "identifier": "112304",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elk River Internal Medicine",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Thomas Philmore Dellinger IV
• Alfred Douglas Earwood, MD
• Michelle Leigh Eggers
• Katherine Kragiel Elder, LCSW
• Elizabeth B. Hill, M.D., PLLC
• Erling L Fredrickson, LISW-CP
• Grandfather Home for Children (Children's Hope Alliance)
• Christine Marie Halterman
• Cindy Allison Herold, MA CCCSLP
• Elizabeth Beu Hill, M.D.

• Multi-Specialty Clinic/Center in Banner Elk, NC
• Providers in Banner Elk, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.