Active NPI
Deltrin Linzell Kimbro, CPRS-S
- Peer Specialist
- Lorain, OH
National Provider Identifier
1609632553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 0002998
- Practice address
- 1939 Oberlin Ave
Lorain, OH 44052-3959 - Phone
- (440) 963-7042
- NPI assigned
- Feb 27, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 0002998 | OH | Primary |
Addresses
Primary practice location
1939 Oberlin Ave
Lorain, OH 44052-3959
Mailing address
1939 Oberlin Ave
Lorain, OH 44052-3959
Phone (440) 963-7042
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0002998 | OH | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Let'S Get Real, Inc. | Peer Specialist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708992000000",
"number": "1609632553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1939 OBERLIN AVE",
"city": "LORAIN",
"state": "OH",
"postal_code": "440523959",
"telephone_number": "440-963-7042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1939 OBERLIN AVE",
"city": "LORAIN",
"state": "OH",
"postal_code": "440523959",
"telephone_number": "440-963-7042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBRO",
"first_name": "DELTRIN",
"middle_name": "LINZELL",
"credential": "CPRS-S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-02-27",
"last_updated": "2024-02-27",
"certification_date": "2024-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "0002998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.