Individual provider Active NPI

Kim E Fishman

  • Audiologist
  • Hopkins, MN
National Provider Identifier
1124212360
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
6400 Issued in MN
Practice address
11 10TH Ave S Ste a
Hopkins, MN 55343-7505
Phone
(952) 767-0672
Fax
(952) 500-9955
NPI assigned
Aug 30, 2007
Last updated
Oct 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 6400 MN Primary

Addresses

Primary practice location

11 10TH Ave S Ste a
Hopkins, MN 55343-7505

Mailing address

11 10TH Ave S Ste a
Hopkins, MN 55343-7505
Phone (952) 767-0672

Other identifiers 1

IdentifierTypeStateIssuer
1689935686OtherNPPES

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080228000087 MN Practitioner - Qualified Audiologist 2961586052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11 10TH Ave S
Suite a
Hopkins, MN 55343-7505
Phone (952) 767-0672

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6400MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Rosner Hearing Inc 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, 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": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1124212360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 10TH AVE S STE A",
            "city": "HOPKINS",
            "state": "MN",
            "postal_code": "553437505",
            "telephone_number": "952-767-0672",
            "fax_number": "952-500-9955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 10TH AVE S STE A",
            "city": "HOPKINS",
            "state": "MN",
            "postal_code": "553437505",
            "telephone_number": "952-767-0672",
            "fax_number": "952-500-9955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHMAN",
        "first_name": "KIM",
        "middle_name": "E",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "6400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1689935686",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hopkins, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.