Individual provider Active NPI

Kimberly McMahon, APRN

  • Acute Care Nurse Practitioner
  • Dover, NH
National Provider Identifier
1205609187
Registry record updated Nov 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
092662-23 Issued in NH
Practice address
789 Central Ave
Dover, NH 03820-2589
Phone
(603) 609-6819
NPI assigned
Nov 2, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 092662-23 NH Primary

Addresses

Primary practice location

789 Central Ave
Dover, NH 03820-2589

Mailing address

117 Old Pine Hill Rd N Apt 11
Berwick, ME 03901-2979
Phone (603) 717-5344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20231220002604 NH Practitioner - Nurse Practitioner 9436509205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

789 Central Ave
Dover, NH 03820-2526
Phone (603) 740-2421

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
092662-23NHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wentworth Douglass Physician Corporation Current Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Jan 15, 2024 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Jan 15, 2024 Accepting new patients
Wentworth Douglass Hospital Past Accepting new patients
Westchester Neurological Consultant PC Past Accepting new patients

Locations

750 Central Ave
Ste Q
Dover, NH 03820
Phone (603) 742-6030

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

67 Corporate Dr
Ste 200
Portsmouth, NH 03801
Phone (603) 431-5529

158 Route 108
Ste 100
Somersworth, NH 03878
Phone (603) 609-6189

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 5

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 2

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": "1698883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699142400000",
    "number": "1205609187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 OLD PINE HILL RD N APT 11",
            "city": "BERWICK",
            "state": "ME",
            "postal_code": "039012979",
            "telephone_number": "603-717-5344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202589",
            "telephone_number": "603-609-6819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMAHON",
        "first_name": "KIMBERLY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-02",
        "last_updated": "2023-11-05",
        "certification_date": "2023-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NH",
            "license": "092662-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.