Kimberly Jacks, AUD

Primary specialty

AudiologistTaxonomy code 231H00000X

License

10161 Issued in MN

Practice address

5565 Blaine Ave Ste 225
Inver Grove Heights, MN 55076-1239

Phone

(404) 297-4230

NPI assigned

Jul 2, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kimberly Lee Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Qualified Audiologist

Education

University of Minnesota Medical School, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/8eec72c0-b1a5-472c-aba8-b566cb8522fc/

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.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment Care Compare group NPD
• Andros ENT & Sleep Center PA

  • Sleep Medicine (Otolaryngology) Physician
  • Inver Grove Heights, MN
  • NPI 1578807491
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • Brooklyn Park, MN
  • NPI 1447668678
  NPD
• ENT of Georgia, LLC

  • Otolaryngology Physician
  • Atlanta, GA
  • NPI 1922046424
  NPD (past)

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

{
    "created_epoch": "1498953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1689195422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NORTHSIDE HOSPITAL MANAGED CARE DEPARTMENT",
            "address_2": "1000 JOHNSON FERRY RD NE",
            "city": "ATLATNA",
            "state": "GA",
            "postal_code": "303423034",
            "telephone_number": "404-851-8097",
            "fax_number": "404-250-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 BLAINE AVE STE 225",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550761239",
            "telephone_number": "404-297-4230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-02",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "GA",
            "license": "AUD004099",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "10161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "LEE",
            "credential": "AUD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Inver Grove Heights Family Medical Center LTD
• Inver Grove Heights WP II, LLC
• Inver Grove Heights WP, LLC
• Inver Wood Healthcare Center Inc
• Inverwood Senior Living LLC
• Bradley Jon Jacobson, HID
• Janelle Jacobson, COTA/L
• Jane E Vanroekel
• Janjua Consulting, LLC
• Liam Mason Johnson-Odegard

• Audiologist in Inver Grove Heights, MN
• Providers in Inver Grove Heights, MN by specialty
• Audiologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.