Individual provider Active NPI

Kimberly A Campbell

  • Clinical Social Worker
  • Bloomfield, CT
National Provider Identifier
1447066048
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11389 Issued in CT
Practice address
693 Bloomfield Ave
Bloomfield, CT 06002-2489
Phone
(860) 731-5522
Fax
(860) 731-5536
NPI assigned
Dec 9, 2024
Last updated
Dec 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 11389 CT Primary

Addresses

Primary practice location

693 Bloomfield Ave
Bloomfield, CT 06002-2489

Mailing address

2 Waterside Xing Ste 401
Windsor, CT 06095-1588
Phone (860) 697-3351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20250107000613 CT Practitioner - Clinical Social Worker 9133657091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Indiana University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Resources, Inc.Group PAC ID 5597652149, 50 clinicians

Practice addresses (Care Compare)

153 Hazard Ave
Enfield, CT 06082-4592
Phone (860) 523-5020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11389CTMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Resources, Inc. CurrentSince Nov 2, 2024 Accepting new patients

Locations

693 Bloomfield Ave
Bloomfield, CT 06002
Phone (860) 243-6584

153 Hazard Ave
Enfield, CT 06082
Phone (860) 253-5020

2 Waterside Xing
Ste 401
Windsor, CT 06095

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": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1447066048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WATERSIDE XING STE 401",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060951588",
            "telephone_number": "860-697-3351",
            "fax_number": "860-731-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "693 BLOOMFIELD AVE",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022489",
            "telephone_number": "860-731-5522",
            "fax_number": "860-731-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

Verify at the official NPI Registry.