Tyler Jerome Kimmel, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12011939A Issued in IN

Practice address

1717 S. Calhoun Street
Fort Wayne, IN 46802

Phone

(260) 458-2641

Fax

(260) 458-3093

NPI assigned

May 20, 2013

Last updated

May 20, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: tyler.kimmel@nhci.eclinicaldirectplus.com

All facility ownership & control disclosures 2

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

Owned or controlled facilities with NPI records 3

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

• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1508262916

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1548291222

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1669879664

  Corporate Officer, W-2 Managing Employee

  CMS ownership

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

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1205272168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S. CALHOUN STREET",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46802",
            "telephone_number": "260-458-2641",
            "fax_number": "260-458-3093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S. CALHOUN STREET",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46802",
            "telephone_number": "260-458-2641",
            "fax_number": "260-458-3093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMMEL",
        "first_name": "TYLER",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-20",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011939A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ken A Kimball, RPH
• Kimberly Loney LLC
• Aaron Kimble, LMHC
• Grace Anne Kimes, RBT
• Eric Ryan Kimmel, M.D.
• Mackenzie Kimpel, CCC-SLP
• Kind Steps Therapy LLC
• Joseph E Kinder
• Kindred Angels LLC
• Kevin Kyle Kinduell, MD

• Dentist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.