Kimberly I Diaz, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA04144 Issued in TX

Practice address

7323 Marbach Rd Ste 104
San Antonio, TX 78227-1905

Phone

(210) 674-0257

Fax

(210) 369-9064

NPI assigned

Nov 15, 2007

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 5

Other names 1

• Kim I Diaz Other name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TX

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, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kellum Medical Group, PAGroup PAC ID 7416981659, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Kellum Medical Group, PA

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1508813494
  Medicare reassignment Care Compare group
• Kellum Physician Partners, PA

  • Obstetrics & Gynecology Physician
  • San Antonio, TX
  • NPI 1073880092
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1366623639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-674-0257",
            "fax_number": "210-369-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-674-0257",
            "fax_number": "210-369-9064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "KIMBERLY",
        "middle_name": "I",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA04144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP PRACTICE TAX ID",
            "identifier": "741833622",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PRACTICE NPI",
            "identifier": "1508813494",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "PA04144",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KIMBERLY I. DIAZ, PA-C - NPI",
            "identifier": "1366623639",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366623639",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.kellummedicalgroup.com",
            "affiliation": "N",
            "endpointDescription": "Practice website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct messaging",
            "address_1": "7323 Marbach Rd Ste 104",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782271905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marbach_ma@kellummedical.com",
            "affiliation": "N",
            "endpointDescription": "Patient/Provider info Request(s)",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "7323 Marbach Rd Ste 104",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782271905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "DIAZ",
            "middle_name": "I",
            "credential": "PREFERRED NAME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kaitlyn Nicole Diaz, PA-C
• Karen C. Diaz, MD
• Karina Diaz, LVN
• Karla Diaz, LVN
• Katherine Diaz
• Leslie Lauren Diaz, LCSW
• Mabel Diaz, LPC
• Marina Diaz, BCBA
• Marisa D Diaz, PHD INTERN
• Marissa Janae Diaz

• Medical Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; 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.