Kimberly Lott, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004095 Issued in GA

Practice address

100 Doctors Dr Ste G
Douglas, GA 31533-2211

Phone

(912) 384-6186

Fax

(912) 384-6187

NPI assigned

Apr 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Kimberly Ricketson Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CRH Physician Practices, LLCGroup PAC ID 5193727964, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• CRH Physician Practices, LLC

  • Multi-Specialty Clinic/Center
  • Douglas, GA
  • NPI 1710046073
  Medicare reassignment Care Compare group
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)
• Westside Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Douglas, GA
  • NPI 1013158948
  NPD (past)

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1306802236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1377",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315341377",
            "telephone_number": "912-384-1477",
            "fax_number": "912-384-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DOCTORS DR STE G",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332211",
            "telephone_number": "912-384-6186",
            "fax_number": "912-384-6187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Doctors Dr Ste S",
            "address_purpose": "LOCATION",
            "city": "Douglas",
            "state": "GA",
            "postal_code": "315332203",
            "country_code": "US",
            "telephone_number": "912-292-0658",
            "fax_number": "912-292-0670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOTT",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173328689C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173328689A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "004095",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173328689B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "RICKETSON",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cheng Hsiung Lin, MD
• Lindsay Optical
• Lindsey, D.M.D., & Crawford, D.M.D., LLC
• Griff M Lindsey, DMD
• Debra B Lister, MD
• Debra Sharon Luke, FNP-C
• Torrey Mack
• W Eric Macleod, MD
• Magnolia House PCH, Inc
• Mahendra G Amin MD PC

• Medical Physician Assistant in Douglas, GA
• Providers in Douglas, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.