NPIMap

Individual provider Active NPI

Kimberley Dorene Evans, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Clearwater, FL
National Provider Identifier
1396840500
Registry record updated Jun 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
ME0085477 Issued in FL
Practice address
1227 S Myrtle Ave
Clearwater, FL 33756-3469
Phone
(727) 939-6196
Fax
(727) 350-9396
NPI assigned
Sep 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X ME0085477 FL Primary

Addresses

Primary practice location

1227 S Myrtle Ave
Clearwater, FL 33756-3469

Mailing address

1227 S Myrtle Ave
Clearwater, FL 33756-3469
Phone (727) 939-6196

Other identifiers 2

IdentifierTypeStateIssuer
P00932367OtherFLMEDICARE RAILROAD PROVIDER NUMBER
265776700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100317000552 FL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 0345375218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
University of Florida College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Senior Care IncGroup PAC ID 7618397886, 32 clinicians

Practice addresses (Care Compare)

2655 State Rd
580 Suite 202
Clearwater, FL 33761-3167
Phone (727) 266-5449

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0085477FLMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventhealth Senior Care Inc Geriatric Medicine CurrentSince Aug 12, 2024 Accepting new patients

Locations

2655 State Road 580
Ste 202
Clearwater, FL 33761
Phone (727) 499-1041

290 Clyde Morris Blvd
Ormond Beach, FL 32174
Phone (386) 615-6642

Interoperability endpoints

  • Direct secure messaging: kevans3401621@adventhealth.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403395200000",
    "number": "1396840500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 S MYRTLE AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563469",
            "telephone_number": "727-939-6196",
            "fax_number": "727-350-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 S MYRTLE AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563469",
            "telephone_number": "727-939-6196",
            "fax_number": "727-350-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KIMBERLEY",
        "middle_name": "DORENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME0085477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD PROVIDER NUMBER",
            "identifier": "P00932367",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265776700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.