Active NPI
Jesse J Kibert, PA
- Medical Physician Assistant
- Canton, NY
National Provider Identifier
1104072388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 014002
- Practice address
- 4 Commerce Lane
Canton, NY 13617-3739 - Phone
- (315) 386-8191
- Fax
- (315) 386-1410
- NPI assigned
- Aug 7, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | KS | ||
| Medical Physician Assistant | 363AM0700X | 014002 | NY | Primary |
Addresses
Primary practice location
4 Commerce Lane
Canton, NY 13617-3739
Mailing address
4 Commerce Lane
P.O. Box 407
Canton, NY 13617-3739
Phone (315) 386-8191
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110809 | Other | KS | BLUE CROSS/BLUE SHIELD GROUP |
| 100427890B | Medicaid | KS | |
| 01995615 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Island Medical Empire State, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Oneonta, NY
- NPI 1053623041
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309910400000",
"number": "1104072388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 COMMERCE LANE",
"address_2": "P.O. BOX 407",
"city": "CANTON",
"state": "NY",
"postal_code": "136173739",
"telephone_number": "315-386-8191",
"fax_number": "315-386-1410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 COMMERCE LANE",
"city": "CANTON",
"state": "NY",
"postal_code": "136173739",
"telephone_number": "315-386-8191",
"fax_number": "315-386-1410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIBERT",
"first_name": "JESSE",
"middle_name": "J",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-07",
"last_updated": "2011-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KS",
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "014002",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD GROUP",
"identifier": "110809",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100427890B",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01995615",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.