NPIMap

Individual provider Active NPI

Jaime Lyn Kibler-McCormick, D.O.

  • Family Medicine Physician
  • Saint Johns, FL
National Provider Identifier
1194796813
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS9402 Issued in FL
Practice address
30 Ardisia Lane
St. Johns, FL 32259
Phone
(904) 287-2794
NPI assigned
Jan 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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 OS9402 FL Primary

Addresses

Primary practice location

30 Ardisia Lane
St. Johns, FL 32259

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-1032

Other practice location 1

1400 Bishop Estates Rd
Credentialing Department
Jacksonville, FL 32259-4244
Phone (904) 287-2794

Other identifiers 2

IdentifierTypeStateIssuer
009172600MedicaidFL
P01321205OtherFLRAILROAD MEDICARE

Other names 1

  • Jaime Kibler Cory Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20070627000019 FL Practitioner - Family Practice 8022117340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

1400 Bishop Estates Rd
Jacksonville, FL 32259-4244
Phone (904) 287-2794

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Inc Family Medicine CurrentSince Feb 14, 2017 Accepting new patients
Baptist Primary Care Inc Family Medicine Current Accepting new patients
Solantic LLC Past Accepting new patients

Locations

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

1400 Bishop Estates Rd
Jacksonville, FL 32259
Phone (904) 287-2794

30 Ardisia Ln
St Johns, FL 32259
Phone (904) 287-2794

Interoperability endpoints

  • Direct secure messaging: jkiblermccormick28189@baptisthealthsystemjacksonville.direct-ci.com

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

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1194796813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ARDISIA LANE",
            "city": "ST. JOHNS",
            "state": "FL",
            "postal_code": "32259",
            "telephone_number": "904-287-2794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Bishop Estates Rd",
            "address_2": "Credentialing Department",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322594244",
            "country_code": "US",
            "telephone_number": "904-287-2794",
            "fax_number": "904-287-5362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIBLER-MCCORMICK",
        "first_name": "JAIME",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009172600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01321205",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAIME",
            "last_name": "CORY",
            "middle_name": "KIBLER",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Johns, FL

Sources for this page

Verify at the official NPI Registry.