Active NPI
Kevin James Zimmerman, DMD
- Dentist
- Warm Springs, OR
National Provider Identifier
1396853644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS035025
- Practice address
- 1270 Kot Num Road
Warm Springs, OR 97761-1209 - Phone
- (541) 553-1196
- Fax
- (541) 553-2135
- NPI assigned
- Aug 28, 2006
- Last updated
- Oct 30, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS035025 | PA | Primary |
Addresses
Primary practice location
1270 Kot Num Road
Warm Springs, OR 97761-1209
Mailing address
1270 Kot Num Road
PO Box 1209
Warm Springs, OR 97761-1209
Phone (541) 553-1196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 273855 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS035025 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1396853644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1270 KOT NUM ROAD",
"address_2": "PO BOX 1209",
"city": "WARM SPRINGS",
"state": "OR",
"postal_code": "977611209",
"telephone_number": "541-553-1196",
"fax_number": "541-553-2135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1270 KOT NUM ROAD",
"city": "WARM SPRINGS",
"state": "OR",
"postal_code": "977611209",
"telephone_number": "541-553-1196",
"fax_number": "541-553-2135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMERMAN",
"first_name": "KEVIN",
"middle_name": "JAMES",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS035025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273855",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warm Springs, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.