Active NPI
Kimber M Stout, MD
- Interventional Cardiology Physician
- Santa Fe, NM
National Provider Identifier
1487658399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- 2003-0705
- Practice address
- 2085 S Pacheco St
Suite a
Santa Fe, NM 87505-5473 - Phone
- (505) 984-8012
- Fax
- (505) 988-2612
- NPI assigned
- Jun 8, 2005
- 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 |
|---|---|---|---|---|
| Interventional Cardiology Physician | 207RI0011X | 2003-0705 | NM | Primary |
Addresses
Primary practice location
2085 S Pacheco St
Suite a
Santa Fe, NM 87505-5473
Mailing address
PO Box 8387
Albuquerque, NM 87198-8387
Phone (505) 841-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51384795 | Medicaid | NM |
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 |
|---|---|---|---|
| 2003-0705 | NM | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Vincent Physician Clinics LLC | Past | Accepting new patients | |
| Eecp LLC | Past | Accepting new patients | |
| New Mexico Heart Institute, LLC | Past | Accepting new patients | |
| Arkansas Cardiology | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Santa Fe, NM
- NPI 1689795635
-
- Cardiovascular Disease Physician
- Albuquerque, NM
- NPI 1346242575
-
- Cardiovascular Disease Physician
- Little Rock, AR
- NPI 1003862848
-
- Family Medicine Physician
- Little Rock, AR
- NPI 1134558398
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363824000000",
"number": "1487658399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8387",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871988387",
"telephone_number": "505-841-1000",
"fax_number": "505-843-2853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 S PACHECO ST",
"address_2": "SUITE A",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875055473",
"telephone_number": "505-984-8012",
"fax_number": "505-988-2612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "KIMBER",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-08",
"last_updated": "2013-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "NM",
"license": "2003-0705",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "51384795",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.