Individual provider Active NPI

Kristina Jill Kirk, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Dayton, OH
National Provider Identifier
1093929275
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
35.084436 Issued in OH
Practice address
1 Childrens PLZ
Dayton, OH 45404-1815
Phone
(937) 641-3600
Fax
(937) 641-5802
NPI assigned
May 9, 2007
Last updated
Oct 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 35.084436 OH Primary

Addresses

Primary practice location

1 Childrens PLZ
Dayton, OH 45404-1815

Mailing address

PO Box 933432
Cleveland, OH 44193-0039
Phone (937) 641-3000

Other practice location 1

1 Childrens Plz
Dayton, OH 45404-1873
Phone (937) 641-3600

Other practice location 2

3333 W Tech Rd
Miamisburg, OH 45342-0955
Phone (937) 641-3400

Other identifiers 1

IdentifierTypeStateIssuer
2748263MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20070626000155 OH Practitioner - Pediatric Medicine 6507965951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Wright State University Boonshoft School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Childrens PLZ
Dayton, OH 45404-1873
Phone (937) 641-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.084436OHMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Children's Specialty Physicians, Inc. CurrentSince Nov 1, 2020 Accepting new patients
Dayton Children's Specialty Physicians, Inc. CurrentSince Nov 1, 2020 Accepting new patients

Locations

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

967 Bellefontaine Ave
Lima, OH 45804
Phone (419) 224-1330

3333 W Tech Rd
Miamisburg, OH 45342
Phone (937) 641-5725

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1093929275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933432",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041815",
            "telephone_number": "937-641-3600",
            "fax_number": "937-641-5802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Plz",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454041873",
            "country_code": "US",
            "telephone_number": "937-641-3600",
            "fax_number": "937-641-5802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420955",
            "country_code": "US",
            "telephone_number": "937-641-3400",
            "fax_number": "937-641-4880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRK",
        "first_name": "KRISTINA",
        "middle_name": "JILL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-09",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "OH",
            "license": "35.084436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2748263",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.