NPIMap

Individual provider Active NPI

Ibuki A Kimura, MD

  • Hospitalist Physician
  • Madison, WI
National Provider Identifier
1194770198
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
39081-020 Issued in WI
Practice address
700 S Park St
St Marys Hospital Dean Medical Center
Madison, WI 53715-1849
Phone
(608) 251-6100
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 39081-020 WI
Hospitalist Physician 208M00000X 39081-020 WI Primary

Addresses

Primary practice location

700 S Park St
St Marys Hospital Dean Medical Center
Madison, WI 53715-1849

Mailing address

700 S Park St
St Marys Hospital Dean Medical Center
Madison, WI 53715-1849
Phone (608) 251-6100

Other identifiers 1

IdentifierTypeStateIssuer
1194770198MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address ikimura10586@direct-ehr-ssmhc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050104001070 WI Practitioner - HospitalistPractitioner - Internal Medicine 6608824818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
University of Chicago, Pritzker School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

700 S Park St
Suite a
Madison, WI 53715-1830
Phone (608) 260-2900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39081-020WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc Internal Medicine CurrentSince Jan 3, 2005 Accepting new patients
Dean Health Systems, Inc. CurrentSince Jan 3, 2005 Accepting new patients

Locations

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

700 S Park St
Ste A
Madison, WI 53715
Phone (608) 260-2900

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

Interoperability endpoints

  • Direct secure messaging: ikimura10586@direct-ehr-ssmhc.com

Organizations & group practices 2

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1194770198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "address_2": "ST MARYS HOSPITAL DEAN MEDICAL CENTER",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151849",
            "telephone_number": "608-251-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "address_2": "ST MARYS HOSPITAL DEAN MEDICAL CENTER",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151849",
            "telephone_number": "608-251-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMURA",
        "first_name": "IBUKI",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "39081-020",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "39081-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194770198",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "700 S Park St",
            "address_2": "St Marys Hospital Dean Medical Center",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151849",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikimura10586@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ikimura10586@direct-ehr-ssmhc.com",
            "address_1": "700 S Park St",
            "address_2": "St Marys Hospital Dean Medical Center",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.