NPIMap

Individual provider Active NPI

Kristin Elizabeth Ito, M.D., M.P.H.

  • Family Medicine Physician
  • Durham, NC
National Provider Identifier
1184652687
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200000832 Issued in NC
Practice address
1301 Fayetteville St
Durham, NC 27707-2325
Phone
(919) 956-4000
Fax
(919) 687-4257
NPI assigned
Jun 30, 2006
Last updated
Sep 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 200000832 NC
Pediatrics Physician 208000000X 200000832 NC
Family Medicine Physician 207Q00000X 200000832 NC Primary

Addresses

Primary practice location

1301 Fayetteville St
Durham, NC 27707-2325

Mailing address

505 Oberlin Rd
Ste 204
Raleigh, NC 27605-1397
Phone (919) 828-0035

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040812001502 NC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 2163495797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1301 Fayetteville St
Durham, NC 27707-2325
Phone (919) 956-4508

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200000832NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln Community Health Center Incorporated CurrentSince May 14, 2012 Accepting new patients
Lincoln Community Health Center Incorporated CurrentSince May 14, 2012 Accepting new patients
Lincoln Community Health Center Incorporated Past Accepting new patients
Wake Teen Medical Services Inc. Past Accepting new patients
Wake Teen Medical Services Inc. Past Accepting new patients
University of North Carolina at Chapel Hill Family Medicine Past Accepting new patients

Locations

1301 Fayetteville St
Durham, NC 27707
Phone (919) 956-4000

2020 Chapel Hill Rd
Ste 28
Durham, NC 27707
Phone (919) 956-4000

309 Crutchfield St
Durham, NC 27704
Phone (919) 560-7305

3727 Fayetteville St
Durham, NC 27707
Phone (919) 956-4519

3901 N Roxboro St
Ste 101
Durham, NC 27704
Phone (919) 473-4100

412 Liberty St
Durham, NC 27701
Phone (919) 683-1722

414 E Main St
Durham, NC 27701
Phone (919) 560-7600

Interoperability endpoints

  • Direct secure messaging: kito125800@direct.medicine.duke.edu

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Walltown ClinicDurham, NC, CCN 341881 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
Lincoln Community Health Center IncorporatedDurham, NC, CCN 341884 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
Lincoln Community Health Center IncorporatedDurham, NC, CCN 341885 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
John H. Lucas Wellness Center at Hillside High SchoolDurham, NC, CCN 341883 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
Lyon Park ClinicDurham, NC, CCN 341882 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
Lincoln Community Health Center IncorporatedDurham, NC, CCN 341802 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
Holton ClinicDurham, NC, CCN 341950 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021
Lakewood ClinicDurham, NC, CCN B61014 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 23, 2021
Apr 23, 2021

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1184652687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 OBERLIN RD",
            "address_2": "STE 204",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051397",
            "telephone_number": "919-828-0035",
            "fax_number": "919-828-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 FAYETTEVILLE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072325",
            "telephone_number": "919-956-4000",
            "fax_number": "919-687-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITO",
        "first_name": "KRISTIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200000832",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200000832",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200000832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.