NPIMap

Individual provider Active NPI

Kimberly Ofoegbu

  • Medical Physician Assistant
  • Danbury, CT
National Provider Identifier
1588913552
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3657 Issued in CT
Practice address
79 Sand Pit Rd Ste 102
Danbury, CT 06810-4010
Phone
(718) 920-8840
NPI assigned
Sep 5, 2012
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3657 CT Primary
Medical Physician Assistant 363AM0700X 015809 NY

Addresses

Primary practice location

79 Sand Pit Rd Ste 102
Danbury, CT 06810-4010

Mailing address

1 East Hayestown Rd. Unit 20
Danbury, CT 06811
Phone (570) 977-1056

Other identifiers 1

IdentifierTypeStateIssuer
1588913551MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140529002090 PA Practitioner - Physician Assistant 6305069915 Reassigns benefits to 1 organization
I20161020000479 CT Practitioner - Physician Assistant 6305069915 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Specialty Care, P.C.Group PAC ID 2567353121, 24 clinicians

Practice addresses (Care Compare)

107 Newtown Rd
Suite 2a
Danbury, CT 06810-4151
Phone (203) 830-4700

488 Main Ave
Norwalk, CT 06851-1008
Phone (203) 857-9218

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
015809NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Physician Group Inc CurrentSince Dec 19, 2018 Accepting new patients
Afc Physicians of Connecticut, PC CurrentSince Sep 1, 2016 Accepting new patients
St Luke's Physician Group Inc CurrentSince Dec 19, 2018 Accepting new patients
Ctuc01 CurrentSince Sep 1, 2016 Accepting new patients
Advanced Audiology & Hearing Aid Services Past Accepting new patients

Locations

2 Main St
Danbury, CT 06810
Phone (203) 826-2140

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Interoperability endpoints

  • Direct secure messaging: kimberly.ofoegbupa.p1@direct.asc.nextgenshare.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1588913552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EAST HAYESTOWN RD. UNIT 20",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "06811",
            "telephone_number": "570-977-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 SAND PIT RD STE 102",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068104010",
            "telephone_number": "718-920-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OFOEGBU",
        "first_name": "KIMBERLY",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "3657",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "015809",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588913551",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danbury, CT

Sources for this page

Verify at the official NPI Registry.