Active NPI
Kelly Marie Kimball
- Dermatology Physician
- Columbus, OH
National Provider Identifier
1598413064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 57.254633
- Practice address
- 3535 Olentangy River Rd
Columbus, OH 43214-3908 - Phone
- (614) 566-5000
- NPI assigned
- Mar 14, 2022
- Last updated
- Jun 1, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 57.254633 | OH | Primary |
Addresses
Primary practice location
3535 Olentangy River Rd
Columbus, OH 43214-3908
Mailing address
4209 State Route 44
Rootstown, OH 44272-9698
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230707002092 | OH | Order and Referring Only - Internal Medicine | 9133588247 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717200000000",
"number": "1598413064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4209 STATE ROUTE 44",
"city": "ROOTSTOWN",
"state": "OH",
"postal_code": "442729698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 OLENTANGY RIVER RD",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432143908",
"telephone_number": "614-566-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "KELLY",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-14",
"last_updated": "2024-06-01",
"certification_date": "2024-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OH",
"license": "57.254633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2024; 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.