Individual provider Active NPI

Kimberly Tobergte, OTR L

  • Contractor
  • Surprise, AZ
National Provider Identifier
1093855447
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ContractorTaxonomy code 171W00000X
License
3714 Issued in AZ
Practice address
15802 N Parkview Place
Surprise, AZ 85374-1234
Phone
(623) 238-0056
NPI assigned
Feb 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X 3714 AZ Primary

Addresses

Primary practice location

15802 N Parkview Place
Surprise, AZ 85374-1234

Mailing address

15422 N 177TH Dr
Surprise, AZ 85388-3100
Phone (623) 455-8613

Other identifiers 1

IdentifierTypeStateIssuer
146259MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3714AZMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dysart Unified School District Past Accepting new patients
Dysart Unified School District Past Accepting new patients

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": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093855447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15422 N 177TH DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853883100",
            "telephone_number": "623-455-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15802 N PARKVIEW PLACE",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853741234",
            "telephone_number": "623-238-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOBERGTE",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "OTR L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "AZ",
            "license": "3714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146259",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.