Traci a. Kimball MD PC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

TRACI A. KIMBALL MD PC

Practice address

10050 Ralston Rd Unit 3
Arvada, CO 80004-4974

Phone

(720) 577-4584

Fax

(720) 577-4587

NPI assigned

Sep 5, 2014

Organization subpart

No

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

Authorized official

Name

Traci A. Kimball, MDNPI 1841337110

Title

Owner

Phone

(720) 557-6510

Specialties & licenses 15

Addresses

Other identifiers 1

Other names 1

• The WISH Clinic Doing business as

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CO2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Traci a. Kimball MD PC

  • Durable Medical Equipment & Medical Supplies
  • Arvada, CO
  • NPI 1174305601

  O20150701000301

  Same enrollment

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Traci A. Kimball, MD CWSP

  • Surgery Physician
  • Arvada, CO
  • NPI 1841337110

  Health & Wellness Coach

  Medicare reassignment NPD Authorized official
• Bonnie Ferrell, FNP

  • Family Nurse Practitioner
  • Denver, CO
  • NPI 1184173213
  Medicare reassignment NPD
• Matthew Emmett Harris, PA-C

  • Physician Assistant
  • Loveland, CO
  • NPI 1255648598
  Medicare reassignment NPD
• Jacqueline Moraa Mogusu

  • General Practice Physician
  • Carrollton, TX
  • NPI 1881162527

  CO

  Medicare reassignment NPD
• Kerri Holman, BSN, RN, CWON

  • Registered Nurse
  • Denver, CO
  • NPI 1538755061

  Wound Care

  NPD (past)

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1326449646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 RALSTON RD UNIT 3",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800044974",
            "telephone_number": "720-577-4584",
            "fax_number": "720-577-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 RALSTON RD UNIT 3",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800044974",
            "telephone_number": "720-577-4584",
            "fax_number": "720-577-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACI A. KIMBALL MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-557-6510",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41180259",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@thewishclinic.com",
            "affiliation": "N",
            "endpointDescription": "customer service email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "communication with our front desk and intake team",
            "address_1": "10050 Ralston Rd Unit 3",
            "city": "Arvada",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800044974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://login.corhio.org/ProAccess/Login",
            "affiliation": "Y",
            "endpointDescription": "login portal access point for WISH clinic QHPs and clinical support staff to extract PHI",
            "affiliationName": "Colorado Regional Health Information Organization",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PHI stored in data servers located in CO/AZ",
            "address_1": "2000 S Colorado Blvd",
            "address_2": "Tower 1 STE 12000",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "80222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The WISH Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Arvada, CO
• Providers in Arvada, CO by specialty
• Multi-Specialty Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.