Kim Harris, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009550 Issued in IN

Practice address

6225 W 56TH St
Suite 100
Indianapolis, IN 46254-7603

Phone

(317) 293-3300

Fax

(317) 293-3437

NPI assigned

Nov 3, 2006

Last updated

Mar 17, 2015By the provider in NPPES

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 2

Other names 1

• Dr. Kim Bottomley Former name

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kim E. Harris, D.D.S., P.C.

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1336218601
  NPD (past) Authorized official
• MFDC of Indiana, Inc

  dba Gentle Dentist - Eagle Creek

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1932694528
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426550400000",
    "number": "1225117989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7755 WALKER CUP DR",
            "city": "BROWNSBURG",
            "state": "IN",
            "postal_code": "461129183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6225 W 56TH ST",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462547603",
            "telephone_number": "317-293-3300",
            "fax_number": "317-293-3437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2015-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200141150B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA NUMBER",
            "identifier": "978759",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "BOTTOMLEY",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeremiah Harris, PT, DPT
• Jordan Harris
• Kathryn Jill Harris, MSW
• Keairia L Harris
• Khloe Harris
• Kim Staci Harris, M.D.
• Kimberly Harris
• Larry Bernard Harris II
• Laura Beth Harris, B.S., PTA
• Lisa E Harris, MD

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.