Active NPI
Mark Kimmel, M.D.
- Hematology & Oncology Physician
- Middletown, CT
National Provider Identifier
1447356522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 031390
- Practice address
- 536 Saybrook Rd
Middletown, CT 06457-4712 - Phone
- (860) 358-2220
- Fax
- (860) 358-2222
- NPI assigned
- Sep 15, 2006
- 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 |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 031390 | CT | Primary |
Addresses
Primary practice location
536 Saybrook Rd
Middletown, CT 06457-4712
Mailing address
536 Saybrook Rd
Middletown, CT 06457-4712
Phone (860) 358-2220
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36503 | Other | CHAMPUS | |
| 533929 | Other | AETNA | |
| 031390 | Other | CT | CONNECTICARE |
| 010031390CT03 | Other | CT | BLUECARE FAMILY PLAN |
| 0V1840 | Other | CT | HEALTHNET |
| P399969 | Other | OXFORD | |
| 1313907 | Medicaid | CT | |
| 010031390CT03 | Other | CT | ANTHEM |
| 0131390 | Other | UNITED HEALTHCARE | |
| 830001803 | Other | CT | RAILROAD MEDICARE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031390 | CT | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447356522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "536 SAYBROOK RD",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "064574712",
"telephone_number": "860-358-2220",
"fax_number": "860-358-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 SAYBROOK RD",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "064574712",
"telephone_number": "860-358-2220",
"fax_number": "860-358-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMMEL",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "CT",
"license": "031390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "36503",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "533929",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "031390",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECARE FAMILY PLAN",
"identifier": "010031390CT03",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "0V1840",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P399969",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1313907",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "010031390CT03",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0131390",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "830001803",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middletown, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.