Active NPI
Blake Steven Kimbrell, M.D.
- Otolaryngology Physician
- Athens, GA
National Provider Identifier
1144545096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 75683
- Practice address
- 150 Nacoochee Ave
Athens, GA 30601-1823 - Phone
- (706) 546-7908
- Fax
- (706) 546-1944
- NPI assigned
- Apr 5, 2010
- Last updated
- Jun 7, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 262561 | MA | |
| Otolaryngology Physician | 207Y00000X | 0101258556 | VA | |
| Otolaryngology Physician | 207Y00000X | 75683 | GA | Primary |
Addresses
Primary practice location
150 Nacoochee Ave
Athens, GA 30601-1823
Mailing address
150 Nacoochee Ave
Athens, GA 30601-1823
Phone (706) 546-7908
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003176590A | Medicaid | GA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bkimbrell@entofathens.gwaydirect.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Otolaryngology
- Education
- Mercer University School of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
150 Nacoochee Ave
Athens, GA 30601-1823
Phone 7065467908250
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 262561 | MA | MD | Otolaryngology Physician |
| 0101258556 | VA | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| ENT of Athens, LLC | Current | Accepting new patients |
Locations
150 Nacoochee Ave
Athens, GA 30601
Phone (706) 546-5689
Interoperability endpoints
- bkimbrell@entofathens.gwaydirect.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Otolaryngology/Facial Plastic Surgery Physician
- Athens, GA
- NPI 1598822280
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Athens, GA
- NPI 1437186111
-
- General Acute Care Hospital
- Monroe, GA
- NPI 1720589328
-
dba St. Mary's Hospital
- General Acute Care Hospital
- Athens, GA
- NPI 1871556621
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1144545096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 NACOOCHEE AVE",
"city": "ATHENS",
"state": "GA",
"postal_code": "306011823",
"telephone_number": "706-546-7908",
"fax_number": "706-546-1944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 NACOOCHEE AVE",
"city": "ATHENS",
"state": "GA",
"postal_code": "306011823",
"telephone_number": "706-546-7908",
"fax_number": "706-546-1944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBRELL",
"first_name": "BLAKE",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-05",
"last_updated": "2021-06-07",
"certification_date": "2021-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MA",
"license": "262561",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "VA",
"license": "0101258556",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "GA",
"license": "75683",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003176590A",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "bkimbrell@entofathens.gwaydirect.com",
"affiliation": "N",
"address_1": "150 Nacoochee Ave",
"city": "Athens",
"state": "GA",
"country_code": "US",
"postal_code": "306011823",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.
- 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.