Active NPI
Brian S Kimball, PA
- Physician Assistant
- Manchester, NH
National Provider Identifier
1699718247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0088
- Practice address
- 100 Hitchcock Way
Manchester, NH 03104-4125 - Phone
- (603) 695-2500
- NPI assigned
- Jun 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0088 | NH | Primary |
Addresses
Primary practice location
100 Hitchcock Way
Manchester, NH 03104-4125
Mailing address
100 Hitchcock Way
Manchester, NH 03104-4125
Phone (603) 695-2500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80000229 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1699718247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 HITCHCOCK WAY",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031044125",
"telephone_number": "603-695-2500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HITCHCOCK WAY",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031044125",
"telephone_number": "603-695-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "BRIAN",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NH",
"license": "0088",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "80000229",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.