Kimberly B Prise, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

209492 Issued in NY

Practice address

4711 Transit Rd
Lancaster, NY 14043-4888

Phone

(716) 668-5331

Fax

(716) 668-5370

NPI assigned

Dec 28, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: prisemd@forestreampediatrics.medentdirect.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.

• Forestream Pediatrics, LLP

  • Pediatric Adolescent Medicine Physician
  • Depew, NY
  • NPI 1407813058
  NPD (past) Authorized official

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1205813680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 TRANSIT RD",
            "city": "LANCASTER",
            "state": "NY",
            "postal_code": "140434888",
            "telephone_number": "716-668-5331",
            "fax_number": "716-668-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 TRANSIT RD",
            "city": "LANCASTER",
            "state": "NY",
            "postal_code": "140434888",
            "telephone_number": "716-668-5331",
            "fax_number": "716-668-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRISE",
        "first_name": "KIMBERLY",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "209492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020521904",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426001948",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "1210687",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "146561DL",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00020521904",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000525567004",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Margaret Petrunyak, M.S. ED. CCC-SLP
• Jessica Pfeifer, FNP
• David Anthony Phillips, D.C.
• Stacy Nicolini Powell, M.S., CCC/SLP
• Devon Powers, AGPCNP
• Mary Raichel
• Redlinski Chiropractic
• Duane Edward Redlinski, DC
• Marlene Jean Redlinski, DC
• Natali Reyes-Diaz

• Pediatrics Physician in Lancaster, NY
• Providers in Lancaster, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.