Individual provider Active NPI

Kimberly Ghelarducci

  • Chiropractor
  • Oklahoma City, OK
National Provider Identifier
1609262997
Registry record updated May 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3979 Issued in OK
Practice address
3600 NW 50TH St Ste C
Oklahoma City, OK 73112
Phone
(405) 976-7397
Fax
(405) 946-7411
NPI assigned
Apr 13, 2015
Last updated
May 16, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3979 OK Primary

Addresses

Primary practice location

3600 NW 50TH St Ste C
Oklahoma City, OK 73112

Mailing address

3600 NW 50TH St Ste C
Oklahoma City, OK 73112-5638
Phone (405) 946-7397

Other practice location 1

7304 N Comanche Ave
Warr Acres, OK 73132-6635
Phone (405) 728-4851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180710000293 OK Practitioner - Chiropractic 1254687031 Receives reassigned benefits from 1 practitioner
Practice locations: Bethany, OK

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

7440 NW 39TH Expy
Bethany, OK 73008-2342
Phone (405) 946-7397

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3979OKMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Brixton Indian Hills LLC Chiropractor Past Accepting new patients
Brixton Square Chiropractic LLC Chiropractor PastSince Jul 29, 2012 Accepting new patients

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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.

NPI Registry JSON

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1609262997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 NW 50TH ST STE C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125638",
            "telephone_number": "405-946-7397",
            "fax_number": "405-946-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 NW 50TH ST STE C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73112",
            "telephone_number": "405-976-7397",
            "fax_number": "405-946-7411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7304 N Comanche Ave",
            "address_purpose": "LOCATION",
            "city": "Warr Acres",
            "state": "OK",
            "postal_code": "731326635",
            "country_code": "US",
            "telephone_number": "405-728-4851",
            "fax_number": "405-728-0443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GHELARDUCCI",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-13",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.