Aleko Kimbouris, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA01159 Issued in RI

Practice address

164 Summit Ave
Providence, RI 02906

Phone

(401) 793-4102

NPI assigned

Jun 29, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, RI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Lifespan Physician Group, Inc.

  dba Brown Health Medical Group

  • General Practice Physician
  • Providence, RI
  • NPI 1407116643
  Medicare reassignment NPD
• Montgomery Brain and Spine LLC

  dba Center for Brain and Spine

  • Neurological Surgery Physician
  • Silver Spring, MD
  • NPI 1831471051

  DC

  Medicare reassignment
• Lifespan Physician Group, Inc.

  dba Brown Health Medical Group

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1568325678
  NPD
• Lifespan Physician Group, Inc.

  dba Brown Health Medical Group

  • Psychiatry Physician
  • Providence, RI
  • NPI 1548506793
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1518195593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFILED STREET",
            "address_2": "SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02906",
            "telephone_number": "401-793-4102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-444-5891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Forest Glen Rd",
            "address_2": "HC115",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209101483",
            "country_code": "US",
            "telephone_number": "301-592-4928",
            "fax_number": "888-768-5553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBOURIS",
        "first_name": "ALEKO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "RI",
            "license": "PA01159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Chang Kim, MD
• Su Gym Kim, M.D.
• Susan Kim, MD
• Brandi Kimble
• Brian A Kimble, MD
• Karen Kimel-Scott, M.D.
• Leslie Renee Kimpler, D.O.
• Reona Kimura, MD
• Peter Christian Kinder
• Whitney King

• Surgical Physician Assistant in Providence, RI
• Providers in Providence, RI by specialty
• Surgical Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.