Individual provider Active NPI

Amie Raye Kimmerly, D.O.

  • Family Medicine Physician
  • Spokane, WA
National Provider Identifier
1154582252
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60215391 Issued in WA
Practice address
322 W North River Dr
Spokane, WA 99201-3208
Phone
(509) 324-6464
NPI assigned
Jun 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OP60215391 WA Primary

Addresses

Primary practice location

322 W North River Dr
Spokane, WA 99201-3208

Mailing address

322 W North River Dr
Spokane, WA 99201-3208
Phone (509) 324-6464

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20110928000178 WA Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 9537330311 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington Family Medicine CurrentSince Jul 3, 2011 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jul 3, 2011 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients

Locations

19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

322 W North River Dr
Spokane, WA 99201
Phone (509) 241-2575

3010 S Southeast Blvd
Ste A
Spokane, WA 99223
Phone (509) 625-3600

14402 E Sprague Ave
Spokane Valley, WA 99216
Phone (509) 922-2525

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 3

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": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1154582252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 W NORTH RIVER DR",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992013208",
            "telephone_number": "509-324-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 W NORTH RIVER DR",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992013208",
            "telephone_number": "509-324-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMMERLY",
        "first_name": "AMIE",
        "middle_name": "RAYE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-20",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60215391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "322 W North River Dr",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992013208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.