NPIMap

Individual provider Active NPI

Kimberly Hagerman, M.D.

  • Family Medicine Physician
  • Wauseon, OH
National Provider Identifier
1487650446
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35076863 Issued in OH
Practice address
128 Depot St
Wauseon, OH 43567-1305
Phone
(419) 335-0351
Fax
(419) 335-0397
NPI assigned
Jun 24, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35076863 OH Primary

Addresses

Primary practice location

128 Depot St
Wauseon, OH 43567-1305

Mailing address

128 Depot Street
Wauseon, OH 43567-1164
Phone (419) 335-0351

Other identifiers 1

IdentifierTypeStateIssuer
2183211MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20090202000131 OH Practitioner - Family Practice 8022006394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Ohio, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hagerman Family Physicians, IncGroup PAC ID 6204824576, 2 clinicians

Practice addresses (Care Compare)

128 Depot St
Wauseon, OH 43567-1305
Phone (419) 335-0351

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.32 of 100Reported as group
Quality
100
Improvement activities
40
Cost
71.54

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35076863OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hagerman Family Physicians, Inc CurrentSince Aug 6, 2001 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Fulton County Health Center Past Accepting new patients
Fulton County Health Center Past Accepting new patients

Locations

128 Depot St
Wauseon, OH 43567
Phone (419) 335-0351

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fulton Manor Nursing & RehabilitationWauseon, OH, CCN 366097 Skilled nursing facility Corporate Director
Adp of the SNF		 Jun 27, 2013
Apr 8, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1487650446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 DEPOT STREET",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435671164",
            "telephone_number": "419-335-0351",
            "fax_number": "419-335-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 DEPOT ST",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435671305",
            "telephone_number": "419-335-0351",
            "fax_number": "419-335-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGERMAN",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-24",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35076863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2183211",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauseon, OH

Sources for this page

Verify at the official NPI Registry.