Individual provider Active NPI

Kimberly Triplett Ferguson, MD

  • Pediatrics Physician
  • Jacksonville, FL
National Provider Identifier
1306409602
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME163617 Issued in FL
Practice address
2121 Park St
Jacksonville, FL 32204-3811
Phone
(904) 387-6200
NPI assigned
Apr 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X ME163617 FL Primary

Addresses

Primary practice location

2121 Park St
Jacksonville, FL 32204-3811

Mailing address

2121 Park St
Jacksonville, FL 32204-3811
Phone (904) 387-6200

Other practice location 1

2200 Childrens Way
Nashville, TN 37232-0005
Phone (615) 936-2555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20190829000921 TN Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 2466780440

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME163617FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vitalmd Group Holding LLC Pediatrics Past Accepting new patients
The Carithers Pediatric Group PastSince Oct 10, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kimberlyferguson@tcpg.allscriptsdirect.net

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": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1306409602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 PARK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043811",
            "telephone_number": "904-387-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 PARK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043811",
            "telephone_number": "904-387-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320005",
            "country_code": "US",
            "telephone_number": "615-936-2555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "KIMBERLY",
        "middle_name": "TRIPLETT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME163617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.