Individual provider Active NPI

Kimberlee Persaud, MD

  • Pediatrics Physician
  • Pinellas Park, FL
National Provider Identifier
1629606876
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2023-01064 Issued in NC
Practice address
7550 43Rd St N
Pinellas Park, FL 33781-3601
Phone
(727) 863-5474
NPI assigned
Mar 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2023-01064 NC Primary

Addresses

Primary practice location

7550 43Rd St N
Pinellas Park, FL 33781-3601

Mailing address

7550 43Rd St N
Pinellas Park, FL 33781-3601

Other practice location 1

5617 Ramsey St
Fayetteville, NC 28311-1423
Phone (910) 984-8229

Other practice location 2

1406 S Main St
Lillington, NC 27546-8960
Phone (910) 984-8229

Other names 1

  • Dr. Kimberlee Rodriguez Bonilla Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200513000033 FL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 5991136657

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2023-01064NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Pinellas Inc Past Accepting new patients
Kidzcare Pediatrics, PC Pediatrics PastSince Aug 1, 2023 Accepting new patients
Kidzcare Pediatrics, PC Pediatrics PastSince Aug 1, 2023 Accepting new patients

Organizations & group practices 3

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": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1629606876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7550 43RD ST N",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337813601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7550 43RD ST N",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337813601",
            "telephone_number": "727-863-5474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5617 Ramsey St",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283111423",
            "country_code": "US",
            "telephone_number": "910-984-8229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1406 S Main St",
            "address_purpose": "LOCATION",
            "city": "Lillington",
            "state": "NC",
            "postal_code": "275468960",
            "country_code": "US",
            "telephone_number": "910-984-8229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERSAUD",
        "first_name": "KIMBERLEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2023-01064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLEE",
            "last_name": "RODRIGUEZ BONILLA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pinellas Park, FL

Sources for this page

Verify at the official NPI Registry.