Individual provider Active NPI

Kimberly K Monroe, M.D.

  • Pediatrics Physician
  • Ann Arbor, MI
National Provider Identifier
1124012984
Registry record updated Jun 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301096296 Issued in MI
Practice address
1500 E Medical Center Drive
12TH Floor CS Mott Childrens Hospital Room 525
Ann Arbor, MI 48109-4280
Phone
(734) 763-5302
NPI assigned
Sep 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-108058 IL
Pediatrics Physician 208000000X 4301096296 MI Primary

Addresses

Primary practice location

1500 E Medical Center Drive
12TH Floor CS Mott Childrens Hospital Room 525
Ann Arbor, MI 48109-4280

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
036108058MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20110113000565 MI Practitioner - Pediatric Medicine 3678762291 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-108058ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W Sparrow Hospital Association CurrentSince Jul 1, 2022 Accepting new patients
Regents of the University of Michigan CurrentSince Jun 30, 2015 Accepting new patients
Edward W. Sparrow Hospital Association Pediatrics Current Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Aug 10, 2010 Accepting new patients
Edward W. Sparrow Hospital Association Pediatrics CurrentSince Jul 1, 2022 Accepting new patients
Regents of the University of Michigan Pediatrics Current Accepting new patients
Regents of the University of Michigan Pediatrics CurrentSince Jun 30, 2015 Accepting new patients
Wa Foote Memorial Hospital, Inc CurrentSince Aug 10, 2010 Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

1500 E Medical Center Dr
Fl 12
Ann Arbor, MI 48109
Phone (734) 615-7845

1500 E Medical Center Dr
Fl 6
Ann Arbor, MI 48109
Phone (734) 764-5302

3621 S State St
#700
Ann Arbor, MI 48108

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

1200 E Michigan Ave
Ste 460
Lansing, MI 48912
Phone (517) 364-2097

Organizations & group practices 8

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1124012984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DRIVE",
            "address_2": "12TH FLOOR CS MOTT CHILDRENS HOSPITAL ROOM 525",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481094280",
            "telephone_number": "734-763-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONROE",
        "first_name": "KIMBERLY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-08",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-108058",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301096296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108058",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.