NPIMap

Individual provider Active NPI

Kimberly A Mickels, M.D.

  • Internal Medicine Physician
  • Grand Island, NE
National Provider Identifier
1689673386
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18645 Issued in NE
Practice address
729 N Custer Ave
Grand Island, NE 68803-4311
Phone
(308) 382-9266
Fax
(308) 382-5290
NPI assigned
Jul 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18645 NE Primary

Addresses

Primary practice location

729 N Custer Ave
Grand Island, NE 68803-4311

Mailing address

729 N Custer Ave
P.O. Box 2339
Grand Island, NE 68803-4311
Phone (308) 382-9266

Other identifiers 2

IdentifierTypeStateIssuer
05980OtherNEBCBS NUMBER
47059252300MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100128000594 NE Practitioner - Internal Medicine 9537264379 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Nebraska College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

729 N Custer Ave
Unmc Physicians Internal Med Assoc of Grand
Grand Island, NE 68803-4311
Phone (308) 382-9266

Emile 42ND St
Omaha, NE 68198-0001
Phone (402) 559-4015

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18645NEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Island Regional Medical Center CurrentSince Jan 4, 2021 Accepting new patients
Unmc Physicians CurrentSince Jul 1, 2016 Accepting new patients
Saint Francis Medical Center Past Accepting new patients
Grand Island Regional Medical Center Past Accepting new patients

Locations

729 N Custer Ave
Grand Island, NE 68803
Phone (308) 382-9266

3533 Prairieview St
Grand Island, NE 68803
Phone (308) 675-4557

987400 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-3405

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-5600

Organizations & group practices 4

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1689673386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 N CUSTER AVE",
            "address_2": "P.O. BOX 2339",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034311",
            "telephone_number": "308-382-9266",
            "fax_number": "308-382-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 N CUSTER AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034311",
            "telephone_number": "308-382-9266",
            "fax_number": "308-382-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELS",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-15",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "18645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "05980",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47059252300",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NE

Sources for this page

Verify at the official NPI Registry.