NPIMap

Individual provider Active NPI

Kimberly Frances Ingersoll, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Raleigh, NC
National Provider Identifier
1336568385
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
2017-02412 Issued in NC
Practice address
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone
(919) 784-3063
Fax
(919) 784-3362
NPI assigned
Apr 7, 2014
Last updated
Dec 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X E-12209 AR
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 2017-02412 NC Primary

Addresses

Primary practice location

4420 Lake Boone TRL
Raleigh, NC 27607-7505

Mailing address

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 784-3063

Other practice location 1

411 E Matthews Ave
Jonesboro, AR 72401-3142
Phone (870) 930-3518

Other practice location 2

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190626001523 AR Practitioner - Pathology 7911231865 Reassigns benefits to 2 organizations
I20220425001184 NC Practitioner - Pathology 7911231865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rex Pathology Associates PAGroup PAC ID 1355444381, 10 clinicians

Practice addresses (Care Compare)

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 784-3063

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.87 of 100Reported as group
Quality
99.47
Improvement activities
40
Cost
83.62

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017-02412NCMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rex Pathology Associates PA Anatomic Pathology & Clinical Pathology CurrentSince May 15, 2022 Accepting new patients
Doctors' Pathology Services, PA Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2019 Accepting new patients
Doctors' Anatomic Pathology Services, PA Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2019 Accepting new patients

Locations

411 E Matthews Ave
Jonesboro, AR 72401
Phone (501) 932-7430

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

5700 Southwyck Blvd
Toledo, OH 43614

Interoperability endpoints

  • Direct secure messaging: kingersoll818963@direct.unc.nchie.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1336568385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 LAKE BOONE TRL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077505",
            "telephone_number": "919-784-3063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 LAKE BOONE TRL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077505",
            "telephone_number": "919-784-3063",
            "fax_number": "919-784-3362"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "411 E Matthews Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724013142",
            "country_code": "US",
            "telephone_number": "870-930-3518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2301 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277054699",
            "country_code": "US",
            "telephone_number": "919-684-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGERSOLL",
        "first_name": "KIMBERLY",
        "middle_name": "FRANCES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-07",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AR",
            "license": "E-12209",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NC",
            "license": "2017-02412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.