Active NPI
Kimberle Lynne Hogge, PA-C
- Physician Assistant
- Waldorf, MD
National Provider Identifier
1568747939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C05727
- Practice address
- 11315 Pembrooke SQ
Suite 110
Waldorf, MD 20603-4806 - Phone
- (301) 843-7232
- NPI assigned
- Oct 18, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA030787 | DC | |
| Physician Assistant | 363A00000X | PA0003586 | CO | |
| Physician Assistant | 363A00000X | C05727 | MD | Primary |
Addresses
Primary practice location
11315 Pembrooke SQ
Suite 110
Waldorf, MD 20603-4806
Mailing address
11315 Pembrooke SQ
Suite 110
Waldorf, MD 20603-4806
Phone (301) 843-7232
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15223531 | Medicaid | CO | |
| 23375 | Other | CO | KAISER COMMERCIAL NUMBER |
Other names 1
- Ms. Kimberle Lynne Baker
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA0003586 | CO | MD | Physician Assistant |
| C05727 | MD | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453248000000",
"number": "1568747939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11315 PEMBROOKE SQ",
"address_2": "SUITE 110",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034806",
"telephone_number": "301-843-7232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11315 PEMBROOKE SQ",
"address_2": "SUITE 110",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034806",
"telephone_number": "301-843-7232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOGGE",
"first_name": "KIMBERLE",
"middle_name": "LYNNE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-18",
"last_updated": "2016-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "DC",
"license": "PA030787",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "PA0003586",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C05727",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15223531",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "23375",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLE",
"last_name": "BAKER",
"middle_name": "LYNNE",
"prefix": "MS.",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.