Kimberly Warren Riesgo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9105137 Issued in FL

Practice address

7800 Sheridan St
Pembroke Pines, FL 33024-2536

Phone

(954) 962-9650

NPI assigned

Jun 29, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Warren Peters Former name

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: kriesgo14011@mhsdirect.net

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.

• Inphynet South Broward LLC

  • Emergency Medicine Physician
  • Hollywood, FL
  • NPI 1871521880
  Medicare reassignment

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615680000000",
    "number": "1669783213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7800 SHERIDAN ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330242536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 SHERIDAN ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330242536",
            "telephone_number": "954-962-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIESGO",
        "first_name": "KIMBERLY",
        "middle_name": "WARREN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-29",
        "last_updated": "2021-03-14",
        "certification_date": "2021-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kriesgo14011@mhsdirect.net",
            "affiliation": "N",
            "address_1": "7800 Sheridan St",
            "city": "Pembroke Pines",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330242536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "PETERS",
            "middle_name": "WARREN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sander Richiez
• Percival George Ricketts, ED.D, LMHC
• Laura Elizabeth Rico, RN
• Tricia A Riddle, FNP-BC
• Ride Well Transit LLC
• Elizabeth Rincon, M.D.
• Jennifer R Riordan Jaquith, LCSW
• Krysten Riordan, PA
• Sabrina Rios
• Rise N Shine Pharmacy

• Physician Assistant in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.