Individual provider Active NPI

Kimberly Gibson, NP

  • Family Nurse Practitioner
  • Rochester, NY
National Provider Identifier
1275927964
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
339311 Issued in NY
Practice address
601 Elmwood Ave
Rochester, NY 14642-0001
Phone
(585) 275-2975
Fax
(585) 273-1250
NPI assigned
Mar 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 634849 NY
Family Nurse Practitioner 363LF0000X 339311 NY Primary

Addresses

Primary practice location

601 Elmwood Ave
Rochester, NY 14642-0001

Mailing address

1 Reitz Pkwy
Pittsford, NY 14534-2205
Phone (585) 645-4892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160425001798 NY Practitioner - Nurse Practitioner 2365752599 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rochester Friendly HomeGroup PAC ID 0042122046, 6 clinicians

Practice addresses (Care Compare)

3156 E Ave
Rochester, NY 14618-3428
Phone (585) 381-1600

Hospital & facility affiliations

  • Rochester General Hospital Hospital, Rochester, NY, CCN 330125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
634849NYMDRegistered Nurse
339311NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester Friendly Home CurrentSince Sep 16, 2017 Accepting new patients

Organizations & group practices 1

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": "1426809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1275927964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 REITZ PKWY",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145342205",
            "telephone_number": "585-645-4892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-275-2975",
            "fax_number": "585-273-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KIMBERLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "634849",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "339311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.