NPIMap

Individual provider Active NPI

Kimberly L. Micus, M.D.

  • Obstetrics & Gynecology Physician
  • Waco, TX
National Provider Identifier
1235199753
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
K2963 Issued in TX
Practice address
120 Hillcrest Medical Blvd
Suite 300
Waco, TX 76712-8948
Phone
(254) 313-6500
Fax
(254) 313-6599
NPI assigned
Mar 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X K2963 TX Primary

Addresses

Primary practice location

120 Hillcrest Medical Blvd
Suite 300
Waco, TX 76712-8948

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 4

IdentifierTypeStateIssuer
037038904MedicaidTX
0370389-01MedicaidTX
160050362OtherTXRR/MEDICARE
80314NOtherTXBLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090819000043 TX Practitioner - Obstetrics/Gynecology 6103970629 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Texas Medical School at San Antonio, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heart of Texas Community Health Center, Inc.Group PAC ID 1153370242, 106 clinicians

Practice addresses (Care Compare)

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Hospital & facility affiliations

  • Baylor Scott & White Medical Center Hillcrest Hospital, Waco, TX, CCN 450101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K2963TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Texas Community Health Center, Inc. CurrentSince May 2, 2018 Accepting new patients
Heart of Texas Community Health Center Inc Current Accepting new patients
Heart of Texas Community Health Center, Inc CurrentSince May 2, 2018 Accepting new patients
Obhg Texas Holdings, P.a. Obstetrics & Gynecology CurrentSince Jun 1, 2023 Accepting new patients
Hillcrest Baptist Medical Center Past Accepting new patients

Locations

12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530

5950 Saratoga Blvd
Corpus Christi, TX 78414
Phone (321) 917-9263

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000

120 Hillcrest Medical Blvd
Ste 300
Waco, TX 76712
Phone (254) 313-6500

1600 Providence Dr
Waco, TX 76707
Phone (254) 313-4200

2400 N Interstate Highway 35 E
Waxahachie, TX 75165
Phone (469) 843-4000

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 1

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1235199753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HILLCREST MEDICAL BLVD",
            "address_2": "SUITE 300",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128948",
            "telephone_number": "254-313-6500",
            "fax_number": "254-313-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICUS",
        "first_name": "KIMBERLY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "K2963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037038904",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0370389-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/MEDICARE",
            "identifier": "160050362",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "80314N",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.