Individual provider Active NPI

Kimberly Ann Fielding-Maddison, MA, CRC,

  • Mental Health Counselor
  • Lutz, FL
National Provider Identifier
1386370385
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH22446 Issued in FL
Practice address
16120 N Florida Ave
Lutz, FL 33549-6129
Phone
(813) 598-4332
NPI assigned
Aug 1, 2022
Last updated
Aug 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MT4701 FL
Mental Health Counselor 101YM0800X MH22446 FL Primary

Addresses

Primary practice location

16120 N Florida Ave
Lutz, FL 33549-6129

Mailing address

2780 E Fowler Ave Ste 428
Tampa, FL 33612-6297
Phone (813) 598-4332

Other names 1

  • Kimberly Ann Fielding Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240404002467 FL Practitioner - Mental Health Counselor 4486092814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

16120 N Florida Ave
Lutz, FL 33549-6129
Phone (813) 598-4332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
MT4701FLMDMarriage & Family Therapist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1386370385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 E FOWLER AVE STE 428",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336126297",
            "telephone_number": "813-598-4332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16120 N FLORIDA AVE",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335496129",
            "telephone_number": "813-598-4332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIELDING-MADDISON",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "MA, CRC,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-01",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT4701",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH22446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "FIELDING",
            "middle_name": "ANN",
            "credential": "MA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lutz, FL

Sources for this page

Verify at the official NPI Registry.