Individual provider Active NPI

Kimberly C Joliet, D.O.

  • Pediatrics Physician
  • West Des Moines, IA
National Provider Identifier
1265797310
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
DO-04816 Issued in IA
Practice address
6000 University Ave
Suite #100
West Des Moines, IA 50266-8203
Phone
(515) 241-2500
NPI assigned
Jul 5, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X DO-04816 IA Primary

Addresses

Primary practice location

6000 University Ave
Suite #100
West Des Moines, IA 50266-8203

Mailing address

6000 University Ave
Ste #100
West Des Moines, IA 50266-8203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20160728001445 IA Practitioner - Pediatric Medicine 0446483150 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO-04816IAMDPediatrics Physician
1313NEMDGerontology Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation Pediatrics CurrentSince Jul 11, 2016 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

8101 Birchwood Ct
Unit R
Urbandale, IA 50131
Phone (515) 471-9363

6000 University Ave
Ste 101
West Des Moines, IA 50266
Phone (515) 241-2320

6000 University Ave
Ste 100
West Des Moines, IA 50266
Phone (515) 241-2500

Interoperability endpoints

  • Direct secure messaging: kcunningham410391@direct.unitypoint.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1265797310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 UNIVERSITY AVE",
            "address_2": "STE #100",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502668203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 UNIVERSITY AVE",
            "address_2": "SUITE #100",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502668203",
            "telephone_number": "515-241-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLIET",
        "first_name": "KIMBERLY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-05",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "DO-04816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Des Moines, IA

Sources for this page

Verify at the official NPI Registry.