Active NPI
Sean L Kimball, DO
- Family Medicine Physician
- Saratoga Springs, NY
National Provider Identifier
1124169453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 249528
- Practice address
- 434 Church St
Saratoga Springs, NY 12866-8627 - Phone
- (518) 769-2893
- Fax
- (518) 207-4487
- NPI assigned
- Feb 9, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 249528 | NY | Primary |
Addresses
Primary practice location
434 Church St
Saratoga Springs, NY 12866-8627
Mailing address
434 Church St
Saratoga Springs, NY 12866-8627
Phone (518) 769-2893
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03028888 | Medicaid | NY | |
| P00642757 | Other | NY | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 17, 2023 through Feb 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 249528 | NY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670371200000",
"number": "1124169453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 CHURCH ST",
"city": "SARATOGA SPRINGS",
"state": "NY",
"postal_code": "128668627",
"telephone_number": "518-769-2893",
"fax_number": "518-207-4487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "434 CHURCH ST",
"city": "SARATOGA SPRINGS",
"state": "NY",
"postal_code": "128668627",
"telephone_number": "518-769-2893",
"fax_number": "518-207-4487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "SEAN",
"middle_name": "L",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2022-12-07",
"certification_date": "2022-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "249528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03028888",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00642757",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saratoga Springs, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.