Susan Potts Kimberly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C003850 Issued in NC

Practice address

6101 Quadrangle Dr
Suite #100
Chapel Hill, NC 27517-8655

Phone

(919) 445-6000

NPI assigned

Nov 4, 2011

Last updated

Jan 7, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Susan Beth Potts Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Open Space Therapy, PLLC

  • Community/Behavioral Health Agency
  • Chapel Hill, NC
  • NPI 1780133223
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1164709135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 SUNSET CREEK CIR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275164628",
            "telephone_number": "703-254-4024",
            "fax_number": "888-972-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 QUADRANGLE DR",
            "address_2": "SUITE #100",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178655",
            "telephone_number": "919-445-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBERLY",
        "first_name": "SUSAN",
        "middle_name": "POTTS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-04",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C003850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "POTTS",
            "middle_name": "BETH",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Young-Ae Kim, CRNA
• Youngsun Jyang Kim, PA-C
• Stephen M Kimani, MD
• Julie Allison Kimball, LCSW
• Mary Ann Barnes Kimball
• Dorothy Kimel-Scott, PT
• Adam Jordan Kimple, MD
• Kelly Smith Kimple, MD
• Caellaigh Naomi Kimpston, MD, PHD
• Kelsey Theresa Kines, MD, PHD

• Clinical Social Worker in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.