Individual provider Active NPI

Kimberly R. Skerven, PH.D.

  • Psychologist
  • Brookfield, WI
National Provider Identifier
1669454088
Registry record updated May 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2800 Issued in WI
Practice address
250 N Sunny Slope Rd
Ste. 128
Brookfield, WI 53005-4809
Phone
(262) 782-2820
NPI assigned
Nov 20, 2005
Last updated
May 18, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2800 WI Primary
Clinical Social Worker 1041C0700X 6989-123 WI

Addresses

Primary practice location

250 N Sunny Slope Rd
Ste. 128
Brookfield, WI 53005-4809

Mailing address

7720 W Eden PL
Milwaukee, WI 53220-1148
Phone (414) 374-8188

Other identifiers 1

IdentifierTypeStateIssuer
43572600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090601000560 WI Practitioner - Clinical Psychologist 3274578281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Behavioral Medicine SCGroup PAC ID 2567488323, 11 clinicians

Practice addresses (Care Compare)

13400 Bishops LN
Suite 290
Brookfield, WI 53005-6254
Phone (414) 248-4726

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6989-123WIMDClinical Social Worker
2800WIMDOptometrist
6989WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Behavioral Medicine, SC Clinical CurrentSince May 14, 2009 Accepting new patients
Aurora Psychiatric Hospital, Inc. Past Accepting new patients

Locations

13400 Bishops Ln
Ste 290
Brookfield, WI 53005
Phone (262) 782-2820

250 N Sunny Slope Rd
Ste 128
Brookfield, WI 53005
Phone (262) 782-2820

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": "1132444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1669454088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7720 W EDEN PL",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532201148",
            "telephone_number": "414-374-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N SUNNY SLOPE RD",
            "address_2": "STE. 128",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054809",
            "telephone_number": "262-782-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKERVEN",
        "first_name": "KIMBERLY",
        "middle_name": "R.",
        "name_prefix": "Ms.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-20",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2800",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "6989-123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43572600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.