Active NPI
Russell Ivan Kimball, LMT
- Massage Therapist
- Aberdeen, SD
National Provider Identifier
1497390942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT11625
- Practice address
- 202 S Main St Ste 450
Aberdeen, SD 57401-4114 - Phone
- (605) 377-5930
- NPI assigned
- Nov 7, 2019
- Last updated
- Nov 7, 2019
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT11625 | SD | Primary |
Addresses
Primary practice location
202 S Main St Ste 450
Aberdeen, SD 57401-4114
Mailing address
202 S Main St Ste 450
Aberdeen, SD 57401-4114
Phone (605) 377-5930
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | aberdeensdmassage@icloud.com | Direct |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT11625 | SD | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Russell Kimball LLC | Massage Therapist | Current | Accepting new patients |
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": "1573084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573084800000",
"number": "1497390942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 S MAIN ST STE 450",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "574014114",
"telephone_number": "605-377-5930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 S MAIN ST STE 450",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "574014114",
"telephone_number": "605-377-5930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "RUSSELL",
"middle_name": "IVAN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-07",
"last_updated": "2019-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "SD",
"license": "MT11625",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "aberdeensdmassage@icloud.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "business email",
"address_1": "202 S Main St Ste 450",
"city": "Aberdeen",
"state": "SD",
"country_code": "US",
"postal_code": "574014114",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Aberdeen, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.