Kim Wadsworth, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OP61075127 Issued in WA

Practice address

405 Black Hills LN SW Ste B2
Olympia, WA 98502-8661

Phone

(360) 688-1151

NPI assigned

May 31, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kim Ha Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 29, 2021 through Dec 29, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1255823654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13082",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985083082",
            "telephone_number": "360-688-1151",
            "fax_number": "360-282-0738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BLACK HILLS LN SW STE B2",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028661",
            "telephone_number": "360-688-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADSWORTH",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-31",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OL60864834",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP61075127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "HA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stanislav Vylet
• Wa Alliance Wound Care Services PLLC
• Rebekah Waag
• Ann L Wade, PT CMPT
• Sarah Jean Wade
• Wagaman Enterprises Inc
• Christina Wagaman, R.D.
• Jeffrey Daniel Wagaman, PH.D.
• Joel R. Wagaman, PH.D.
• Susan Lyn Wagaman, LMHCA

• Family Medicine Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.