NPIMap

Individual provider Active NPI

Kimberly M Wirths, M.D.

  • Family Medicine Physician
  • Altus, OK
National Provider Identifier
1619922416
Registry record updated Sep 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30873 Issued in OK
Practice address
205 S Park LN
Altus, OK 73521-5755
Phone
(580) 379-6650
Fax
(580) 379-6659
NPI assigned
May 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-25854 KS
Family Medicine Physician 207Q00000X 30873 OK Primary

Addresses

Primary practice location

205 S Park LN
Altus, OK 73521-5755

Mailing address

205 S Park LN
Altus, OK 73521-5755
Phone (580) 379-6650

Other identifiers 5

IdentifierTypeStateIssuer
100179250 DMedicaidKS
100179250CMedicaidKS
200550380AMedicaidOK
203284955MedicaidMO
1619922416MedicaidMO

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 Medicine

State licenses

LicenseStateTypeSpecialty
04-25854KSMDFamily Medicine Physician
30873OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hosp Phcy Past Accepting new patients
Kimberly M. Wirths, MD, PA Family Medicine PastSince May 7, 2008 Accepting new patients
Geary County Hospital Past Accepting new patients
Geary County Hospital Family Medicine Past Accepting new patients

Organizations & group practices 4

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409702400000",
    "number": "1619922416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 S PARK LN",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215755",
            "telephone_number": "580-379-6650",
            "fax_number": "580-379-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S PARK LN",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215755",
            "telephone_number": "580-379-6650",
            "fax_number": "580-379-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTHS",
        "first_name": "KIMBERLY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2014-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-25854",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "30873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100179250 D",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100179250C",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200550380A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203284955",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619922416",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Altus, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.