Individual provider Active NPI

Kimberly K Tyus, M.D.

  • Hospitalist Physician
  • Lafayette, IN
National Provider Identifier
1548453095
Registry record updated Feb 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
01068081A Issued in IN
Practice address
2600 Ferry St
Lafayette, IN 47904-3055
Phone
(765) 448-8000
NPI assigned
Aug 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BS5741663 MO
Hospitalist Physician 208M00000X 01068081A IN Primary

Addresses

Primary practice location

2600 Ferry St
Lafayette, IN 47904-3055

Mailing address

PO Box 5545
Lafayette, IN 47903-5545
Phone (765) 448-8000

Other identifiers 2

IdentifierTypeStateIssuer
000000656862OtherINANTHEM PROVIDER NUMBER
200980500MedicaidIN

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, Master of Science

State licenses

LicenseStateTypeSpecialty
BS5741663MOMDInternal Medicine Physician
01068081AINMDHospitalist Physician

NPI Registry JSON

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

{
    "created_epoch": "1187395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297641600000",
    "number": "1548453095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5545",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479035545",
            "telephone_number": "765-448-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 FERRY ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043055",
            "telephone_number": "765-448-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYUS",
        "first_name": "KIMBERLY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-18",
        "last_updated": "2011-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "BS5741663",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01068081A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000656862",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200980500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.