Kim Graves, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C6829 Issued in AR

Practice address

601 W McKennon St
Clarksville, AR 72830-3523

Phone

(479) 754-8384

Fax

(479) 754-7141

NPI assigned

Jan 25, 2006

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 11

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Mary'S Physician Services LLC

  • General Practice Physician
  • Russellville, AR
  • NPI 1124084991
  Medicare reassignment NPD
• St Marys Physician Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Russellville, AR
  • NPI 1063626117
  NPD
• Johnson Regional Medical Center

  • Land Ambulance
  • Clarksville, AR
  • NPI 1275753881
  NPD (past)
• St Marys Physician Services, LLC

  • Interventional Cardiology Physician
  • Russellville, AR
  • NPI 1720356207
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1245200971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 668",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728300668",
            "telephone_number": "479-754-8384",
            "fax_number": "479-754-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W MCKENNON ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303523",
            "telephone_number": "479-754-8384",
            "fax_number": "479-754-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C6829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INSURANCE COMPANY",
            "identifier": "5306124",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG PROGRAM",
            "identifier": "020407900",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "0790780001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "401067",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA H&R FUNDS",
            "identifier": "0062731",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2124296",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "13692000000",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD ARK",
            "identifier": "51967",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112436001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE/PALMETT",
            "identifier": "080078696",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS OF MICHIGAN",
            "identifier": "XX12984",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hailey Elizabeth Gonzalez, COTA
• J. David Goodman, M.D.
• Jennifer Goodman, CMP
• Ashlynn Goodwin
• Jennifer Graff, CMP
• Kaci Leigh Green, PHARMD
• McKenzie Greeson
• Taylor Gregory, RECOVERY ASSISTANT
• Savannah Grimes, RECOVERY ASSISTANT
• Hope Grissom, LPN

• Family Medicine Physician in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.