Active NPI
Michael Dale Kimmel, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1508967985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW#20738
- Practice address
- 5100 Marlborough Dr
San Diego, CA 92116-2020 - Phone
- (619) 582-0771
- Fax
- (619) 584-4697
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW#20738 | CA | Primary |
Addresses
Primary practice location
5100 Marlborough Dr
San Diego, CA 92116-2020
Mailing address
5100 Marlborough Dr
San Diego, CA 92116-2020
Phone (619) 582-0771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2016 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW#20738 | CA | MD | Clinical Social Worker |
| 20738 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508967985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 MARLBOROUGH DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921162020",
"telephone_number": "619-582-0771",
"fax_number": "619-584-4697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5100 MARLBOROUGH DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921162020",
"telephone_number": "619-582-0771",
"fax_number": "619-584-4697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMMEL",
"first_name": "MICHAEL",
"middle_name": "DALE",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW#20738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.