Kim E Pershall MD PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

J3574 Issued in TX

Legal business name

KIM E PERSHALL MD PA

Practice address

3811 24TH Street
Lubbock, TX 79410-1813

Phone

(806) 796-0202

Fax

(806) 796-0496

NPI assigned

Jan 10, 2008

Organization subpart

No

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

Authorized official

Name

Kim E. Pershall, MDNPI 1497751663

Title

Physician Owner

Phone

(806) 796-0202

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kim E Pershall, MD

  • Otolaryngology Physician
  • Lubbock, TX
  • NPI 1497751663
  Medicare reassignment Care Compare group NPD Authorized official
• Brandi Murphy

  • Audiologist
  • Lubbock, TX
  • NPI 1114387305
  Medicare reassignment Care Compare group NPD
• Tammie Beth Van Liew, F.N.P.

  • Family Nurse Practitioner
  • Lubbock, TX
  • NPI 1639175805
  NPD (past)

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1649456542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 24TH STREET",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101813",
            "telephone_number": "806-796-0202",
            "fax_number": "806-796-0496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 24TH STREET",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101813",
            "telephone_number": "806-796-0202",
            "fax_number": "806-796-0496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM E PERSHALL MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "PERSHALL",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "806-796-0202",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "J3574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "121351100",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034333701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "148127701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "040007969",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37234",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8P8420",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kidney Disease Associates
• Kidney Disease Specialists of West Texas PA
• Joseph Kimberly Killeen, MD
• Debra Killian, LVN
• Audie Gwyn Kilpatrick, PHARM. D.
• Nayeon Kim Thiesse, MD
• Charles Kim, D.O.
• Hyun Ah Kim
• Jeong Han Kim, PH.D., CRC
• Jin Heun Kim

• Otolaryngology Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Otolaryngology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.