Kimberly A Wollmuth, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD26983 Issued in OR

Practice address

9555 SW Barnes Rd Ste 301
Portland, OR 97225-6670

Phone

(503) 297-3371

Fax

(503) 297-7975

NPI assigned

Nov 15, 2006

Last updated

May 28, 2021By the provider in NPPES

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 identifiers 1

Other names 1

• Kimberly Anne Burdick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kwollmuth88919@direct.lhs.org

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.

• Childrens Clinic PC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1649219411
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1679646095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 SW BARNES RD STE 301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256670",
            "telephone_number": "503-297-3371",
            "fax_number": "503-297-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 SW BARNES RD STE 301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256670",
            "telephone_number": "503-297-3371",
            "fax_number": "503-297-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLMUTH",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD26983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28532",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BURDICK",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Walter Wollert, PH.D.
• Abby Wollman
• Brie Ann Wollman
• Laura Wollman, N.D.
• Jason Roland Wollmuth, M.D.
• Adrienne Wolmark, PH.D.
• Dara Lee Wolochow, L.C.S.W.
• Keri Wolsky
• April J Wolstencroft, FNP
• Margaret Wolszon, LCSW

• Pediatrics Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.