Kimberly A Jividen, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

COA.16207-NP Issued in OH

Practice address

483 Court St
Elizabeth, WV 26143-1109

Phone

(304) 275-3301

Fax

(304) 275-4798

NPI assigned

Jul 9, 2014

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Camden-Clark Physician CorporationGroup PAC ID 5294885661, 345 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Camden Clark Medical Center Hospital, Parkersburg, WV, CCN 510058

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjividen332909@direct.wvuhsdirect.com

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.

• Camden-Clark Physician Corporation

  • Surgery Physician
  • Parkersburg, WV
  • NPI 1710125430
  Medicare reassignment Care Compare group NPD
• West Virginia University Medical Corporation

  dba University Health Associates

  • Family Medicine Physician
  • Morgantown, WV
  • NPI 1275504508
  Medicare reassignment NPD
• Wirt County Health Services Association Inc

  dba Ripley Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Ripley, WV
  • NPI 1043401730
  Medicare reassignment NPD
• Wirt County Health Services Association Inc

  dba Parkersburg Family Care B

  • Federally Qualified Health Center (FQHC)
  • Parkersburg, WV
  • NPI 1548777527
  Medicare reassignment NPD
• West Virginia University Medical Corporation

  dba Crisis Support and Recovery Center

  • Community/Behavioral Health Agency
  • Martinsburg, WV
  • NPI 1174233530
  NPD
• Wirt County Health Services Association, Inc

  dba RiverValley Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Ravenswood, WV
  • NPI 1356403703
  NPD
• Wirt County Health Services Association, Inc

  dba Wirt County Family Care

  • Federally Qualified Health Center (FQHC)
  • Elizabeth, WV
  • NPI 1538179411
  NPD
• Camden Clark Memorial Hospital Corporation

  dba Camden Clark Medical Center

  • General Acute Care Hospital
  • Parkersburg, WV
  • NPI 1699704254
  NPD (past)

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

• Camden Clark Memorial Hospital Corporation

  • General Acute Care Hospital
  • Parkersburg, WV
  • NPI 1508160268
  Care Compare affiliation
• Camden Clark Memorial Hospital Corporation

  dba Camden Clark Medical Center

  • General Acute Care Hospital
  • Parkersburg, WV
  • NPI 1699704254
  Care Compare affiliation

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1205242369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "ELIZABETH",
            "state": "WV",
            "postal_code": "261430609",
            "telephone_number": "304-275-3301",
            "fax_number": "304-275-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 COURT ST",
            "city": "ELIZABETH",
            "state": "WV",
            "postal_code": "261431109",
            "telephone_number": "304-275-3301",
            "fax_number": "304-275-4798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIVIDEN",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "58709",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN298807",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.16207-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - MHCPI",
            "identifier": "P01439933",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205242369",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810029263",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0107154",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Hoover
• James R. Toothman DO PLLC
• Rachael Yoder Jarvis, LICSW
• Joy Jenkins
• Arlene Jett
• Cindy John
• Stormy Lynn Johnson
• Tiffany A Johnston, RN
• Christina Jones
• Mikayla Kirby

• Family Nurse Practitioner in Elizabeth, WV
• Providers in Elizabeth, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2018; 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.