Potomac Health Medical of Ca PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

POTOMAC HEALTH MEDICAL OF CA PC

Practice address

11 Piedmont Road
Larkspur, CA 94939

Phone

(860) 282-4128

NPI assigned

Oct 12, 2022

Last updated

Nov 17, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jay A Kimmel, MD

Title

President/Owner

Phone

(860) 282-4128

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1417672437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 HIGH RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069051221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 PIEDMONT ROAD",
            "city": "LARKSPUR",
            "state": "CA",
            "postal_code": "94939",
            "telephone_number": "860-282-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC HEALTH MEDICAL OF CA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "KIMMEL",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "860-282-4128",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramon A. Partida, M.D.
• Frank Peronetto, PT
• Margaret Emily Peterson, R.N.F.A.
• Steve Pickell, P.T.
• Mykaela Poe
• Alex V. Prescott, MD
• Christine Price
• Prima Medical Foundation
• Prima Medical Foundation
• Trisha Rae Quan, M.A.T., A.T.C,

• Specialist in Larkspur, CA
• Providers in Larkspur, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.