Kimberly Carolyn Johnson Gilliam, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

OS017109 Issued in PA

Practice address

1401 S 4TH St
Philadelphia, PA 19147-5948

Phone

(215) 339-1070

Fax

(215) 339-1080

NPI assigned

Apr 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Psychiatry

Education

Philadelphia College of Osteopathic Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Princeton House Provider Group LLCGroup PAC ID 0244540540, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Princeton House Provider Group LLC

  • Psychiatry Physician
  • Princeton, NJ
  • NPI 1881078681
  Medicare reassignment Care Compare group NPD
• Princeton Healthcare System, a New Jersey Non-Profit Corporation

  • Psychiatric Hospital Unit
  • Princeton, NJ
  • NPI 1518009588
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1154594273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 N 6TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234004",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S 4TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191475948",
            "telephone_number": "215-339-1070",
            "fax_number": "215-339-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON GILLIAM",
        "first_name": "KIMBERLY",
        "middle_name": "CAROLYN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MB08474800",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OS017109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Anne John, MD
• Janae Johns
• Angelica Johnsen, MD
• Joyce Johnsen, CCC-SLP
• Johnson Adult Center
• Ashley Johnson Whiting, NP
• Angela C Johnson-Brooks, LMT
• Joanne Johnson-Buda, LCSW
• Cynthia R Johnson-Lewis, M.S
• Markeya Johnson-Williams

• Psychiatry Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; 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.

Verify at the official NPI Registry.