NPIMap

Individual provider Active NPI

Shane P Kimball, D.O.

  • Nephrology Physician
  • Little Rock, AR
National Provider Identifier
1396747606
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
E3391 Issued in AR
Practice address
9601 Baptist Health Dr Ste 400
Little Rock, AR 72205-6399
Phone
(501) 224-2141
Fax
(015) 224-0506
NPI assigned
Jun 1, 2005
Last updated
May 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X E3391 AR Primary

Addresses

Primary practice location

9601 Baptist Health Dr Ste 400
Little Rock, AR 72205-6399

Mailing address

9601 Baptist Health Dr Ste 400
Little Rock, AR 72205-6399
Phone (501) 224-2141

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080520000372 AR Practitioner - NephrologyPractitioner - Internal Medicine 9931278728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Renal ConsultantsGroup PAC ID 4981772027, 5 clinicians

Practice addresses (Care Compare)

9601 Baptist Health Dr
Suite 400
Little Rock, AR 72205-6399
Phone (501) 224-2141

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.79 of 100Reported as group
Quality
63.97
Improvement activities
40
Cost
77.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E3391ARMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Renal Consultants Nephrology CurrentSince Jun 24, 2004 Accepting new patients
Nutrition for You LLC CurrentSince Aug 13, 2018 Accepting new patients

Locations

500 S University Ave
Ste 219
Little Rock, AR 72205
Phone (501) 227-7797

9601 Baptist Health Dr
Little Rock, AR 72205
Phone (501) 202-3995

9601 Baptist Health Dr
Ste 400
Little Rock, AR 72205
Phone (501) 224-2141

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EDCEBA
  • Direct secure messaging: skimball31279@direct.acumenmd.com

Organizations & group practices 2

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 8

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": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1396747606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9601 BAPTIST HEALTH DR STE 400",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056399",
            "telephone_number": "501-224-2141",
            "fax_number": "501-224-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9601 BAPTIST HEALTH DR STE 400",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056399",
            "telephone_number": "501-224-2141",
            "fax_number": "015-224-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "SHANE",
        "middle_name": "P",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E3391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.