Active NPI
Kim Michele Summers, CNP
- Adult Health Nurse Practitioner
- Cleveland, OH
National Provider Identifier
1588005409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 24733
- Practice address
- 1001 Lakeside Ave E
Suite 1000
Cleveland, OH 44114-1158 - Phone
- (216) 308-1793
- Fax
- (855) 569-4705
- NPI assigned
- Jul 8, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 24733 | OH | Primary |
Addresses
Primary practice location
1001 Lakeside Ave E
Suite 1000
Cleveland, OH 44114-1158
Mailing address
PO Box 704
Brunswick, OH 44212-0704
Phone (330) 606-7296
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588005409 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140408000802 | OH | Order and Referring Only - Nurse Practitioner | 3375775273 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24733 | OH | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564099200000",
"number": "1588005409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 704",
"city": "BRUNSWICK",
"state": "OH",
"postal_code": "442120704",
"telephone_number": "330-606-7296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 LAKESIDE AVE E",
"address_2": "SUITE 1000",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441141158",
"telephone_number": "216-308-1793",
"fax_number": "855-569-4705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERS",
"first_name": "KIM",
"middle_name": "MICHELE",
"credential": "CNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-08",
"last_updated": "2019-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "OH",
"license": "24733",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1588005409",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.