Individual provider Active NPI

Kimberly Ann Clare, M.D.

  • Pediatric Adolescent Medicine Physician
  • Poughkeepsie, NY
National Provider Identifier
1689642852
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
2183061 Issued in NY
Practice address
1 Webster Ave Ste 302
Poughkeepsie, NY 12601-1362
Phone
(845) 454-4200
Fax
(845) 452-2075
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 2183061 NY Primary

Addresses

Primary practice location

1 Webster Ave Ste 302
Poughkeepsie, NY 12601-1362

Mailing address

1 Webster Ave Ste 302
Poughkeepsie, NY 12601-1362
Phone (845) 454-4200

Other identifiers 1

IdentifierTypeStateIssuer
02281969MedicaidNY

Other names 1

  • Kimberly Clare Ticknor Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221129001906 NY Practitioner - Pediatric Medicine 4789052564 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2183061NYMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Childrens Health Physicians LLP CurrentSince Jul 1, 2024 Accepting new patients
Boston Children'S Health Physicians, LLP Adolescent Medicine CurrentSince Jul 1, 2024 Accepting new patients

Locations

200 Westage Business Ctr Dr
Ste 111
Fishkill, NY 12524
Phone (845) 896-4505

19 Bradhurst Ave
Hawthorne, NY 10532
Phone (914) 493-7235

1 Webster Ave
Ste 302
Poughkeepsie, NY 12601
Phone (845) 454-4200

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kimberly.clare.p1@direct.cwpw.nextgenshare.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1689642852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WEBSTER AVE STE 302",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011362",
            "telephone_number": "845-454-4200",
            "fax_number": "845-452-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WEBSTER AVE STE 302",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011362",
            "telephone_number": "845-454-4200",
            "fax_number": "845-452-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARE",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "2183061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02281969",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "CLARE TICKNOR",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.