Active NPI
Sandy Jean Kimmel, D.O.
- Neurology Physician
- Raleigh, NC
National Provider Identifier
1598714313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 200400893
- Practice address
- 3400 Executive Dr
Suite 203
Raleigh, NC 27609-7476 - Phone
- (919) 872-0390
- Fax
- (919) 872-0391
- NPI assigned
- May 9, 2006
- Last updated
- Jun 27, 2011
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 200400893 | NC | Primary |
Addresses
Primary practice location
3400 Executive Dr
Suite 203
Raleigh, NC 27609-7476
Mailing address
3400 Executive Dr
Suite 203
Raleigh, NC 27609-7476
Phone (919) 872-0390
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137PC | Other | NC | BLUE CROSS/BLUE SHIELD |
| 89137PC | Medicaid | NC |
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 Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlantic Radiology Associates PA | Past | Accepting new patients | |
| Neurology and Pain Management Center, PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Diagnostic Radiology Physician
- Goldsboro, NC
- NPI 1184656936
-
- Specialist
- Lillington, NC
- NPI 1609907138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309132800000",
"number": "1598714313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 EXECUTIVE DR",
"address_2": "SUITE 203",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276097476",
"telephone_number": "919-872-0390",
"fax_number": "919-872-0391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 EXECUTIVE DR",
"address_2": "SUITE 203",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276097476",
"telephone_number": "919-872-0390",
"fax_number": "919-872-0391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMMEL",
"first_name": "SANDY",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-09",
"last_updated": "2011-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NC",
"license": "200400893",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "137PC",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89137PC",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.