Active NPI
Jon Potter Kimball, MD
- Orthopaedic Surgery Physician
- Clearwater, FL
National Provider Identifier
1205917374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- ME96185
- Practice address
- 1988 Gulf to Bay Blvd
Clearwater, FL 33765-3550 - Phone
- (727) 953-8090
- Fax
- (727) 953-8088
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 2013-00103 | NC | |
| Orthopaedic Surgery Physician | 207X00000X | ME96185 | FL | Primary |
Addresses
Primary practice location
1988 Gulf to Bay Blvd
Clearwater, FL 33765-3550
Mailing address
1988 Gulf to Bay Blvd
Clearwater, FL 33765-3550
Phone (727) 953-8090
Other practice location 1
120 William Penn Plz
Durham, NC 27704-2150
Phone (919) 220-5255
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17EIV | Other | FL | BCBS |
| 177VX | Other | NC | BCBSNC PROVIDER ID NUMBER |
| 856543 | Other | FL | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Orthopedic Surgery
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1988 Gulf to Bay Blvd
Suite 1
Clearwater, FL 33765-3550
Phone (727) 953-8090
Hospital & facility affiliations
- Intermountain Health Utah Valley Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Laminectomy or laminotomy (partial removal of spine bones) | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME96185 | FL | MD | Orthopaedic Surgery Physician |
| 2013-00103 | NC | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Spine Institute, LLC | Orthopaedic Surgery | Current | Accepting new patients |
| Naps Medical LLC | Orthopaedic Surgery | Past | Accepting new patients |
Locations
1988 Gulf To Bay Blvd
Ste 1
Clearwater, FL 33765
Phone (727) 953-8090
1988 Gulf To Bay Blvd
Clearwater, FL 33765
Phone (727) 314-4243
Networks
- Optimum HealthCare HMO Network
Organizations & group practices 2
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.
-
- Interventional Pain Medicine Physician
- Tampa, FL
- NPI 1477183085
Orthopaedic Surgery
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Provo, UT
- NPI 1114025491
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656547200000",
"number": "1205917374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1988 GULF TO BAY BLVD",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337653550",
"telephone_number": "727-953-8090",
"fax_number": "727-953-8088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1988 GULF TO BAY BLVD",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337653550",
"telephone_number": "727-953-8090",
"fax_number": "727-953-8088"
}
],
"practiceLocations": [
{
"address_1": "120 William Penn Plz",
"address_purpose": "LOCATION",
"city": "Durham",
"state": "NC",
"postal_code": "277042150",
"country_code": "US",
"telephone_number": "919-220-5255",
"fax_number": "919-313-1276",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIMBALL",
"first_name": "JON",
"middle_name": "POTTER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2022-06-30",
"certification_date": "2022-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NC",
"license": "2013-00103",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "FL",
"license": "ME96185",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "17EIV",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSNC PROVIDER ID NUMBER",
"identifier": "177VX",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "856543",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clearwater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.