Individual provider Active NPI

Kimberly M Donaldson, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1275937765
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5842 Issued in AZ
Practice address
2902 W Agua Fria Fwy Ste 1090
Phoenix, AZ 85027-3970
Phone
(602) 648-5444
Fax
(602) 772-3801
NPI assigned
Oct 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5842 AZ
Physician Assistant 363A00000X 5842 AZ Primary

Addresses

Primary practice location

2902 W Agua Fria Fwy Ste 1090
Phoenix, AZ 85027-3970

Mailing address

15445 N 2ND Dr
Phoenix, AZ 85023-3627
Phone (520) 591-3066

Other names 1

  • Kimberly Marie Suida Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20150224001930 AZ Practitioner - Physician Assistant 9739405499 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Specialists of North America PLLCGroup PAC ID 7719014505, 310 clinicians

Practice addresses (Care Compare)

20333 N 19TH Ave
Suite 230
Phoenix, AZ 85027-9901
Phone (602) 772-3800

5620 E Bell Rd
Scottsdale, AZ 85254-5950
Phone (602) 385-2115

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5842AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Specialists of North America, PLLC CurrentSince Oct 27, 2023 Accepting new patients
Orthopedic Specialists of North America, PLLC CurrentSince Oct 27, 2023 Accepting new patients
City of Phoenix Arizona PastSince Oct 1, 2020 Accepting new patients

Locations

18555 N 79th Ave
Ste E101
Glendale, AZ 85308
Phone (602) 631-3161

14044 W Camelback Rd
Ste 126
Litchfield Park, AZ 85340
Phone (623) 846-7614

19636 N 27th Ave
Ste 401
Phoenix, AZ 85027
Phone (602) 298-8888

2902 W Agua Fria Fwy
Ste 1090
Phoenix, AZ 85027
Phone (620) 648-5444

19829 N 27th Ave
Phoenix, AZ 85027
Phone (602) 879-5720

2355 E Camelback Rd
Ste 325
Phoenix, AZ 85016
Phone (602) 772-3795

5620 E Bell Rd
Scottsdale, AZ 85254
Phone (602) 485-3050

14733 W Mountain View Blvd
Bldg F
Surprise, AZ 85374
Phone (602) 892-0917

Organizations & group practices 4

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": "1413158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1275937765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15445 N 2ND DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850233627",
            "telephone_number": "520-591-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 W AGUA FRIA FWY STE 1090",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273970",
            "telephone_number": "602-648-5444",
            "fax_number": "602-772-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONALDSON",
        "first_name": "KIMBERLY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-13",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "5842",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SUIDA",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.