NPIMap

Individual provider Active NPI

Kimberly S Williamson, CPO, CFM

  • Customized Equipment (DME)
  • Eliz City, NC
National Provider Identifier
1699788372
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Practice address
106 Medical Drive
Eliz City, NC 27909
Phone
(252) 338-3002
Fax
(252) 338-2902
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotist 222Z00000X CPO03814 NC
Prosthetist 224P00000X CPO03814 NC
Customized Equipment (DME) 332BC3200X NC Primary

Addresses

Primary practice location

106 Medical Drive
Eliz City, NC 27909

Mailing address

106 Medical Drive
PO Box 1471
Eliz City, NC 27909
Phone (252) 338-3002

Other identifiers 4

IdentifierTypeStateIssuer
0482POtherNCBCBS
9190511MedicaidVA
384410OtherVABCBS
7701327MedicaidNC

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CPO03814NCMDProsthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Albemarle Orthotics & Prosthetics, Inc Orthotist Past Accepting new patients
Albemarle Orthotics & Prosthetics, Inc Orthotist Past Accepting new patients
Albemarle Orthotics & Prosthetics, Inc Orthotist Past Accepting new patients
Albemarle Orthotics & Prosthetics, Inc Orthotist Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1699788372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 MEDICAL DRIVE",
            "address_2": "PO BOX 1471",
            "city": "ELIZ CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-338-3002",
            "fax_number": "252-338-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MEDICAL DRIVE",
            "city": "ELIZ CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-338-3002",
            "fax_number": "252-338-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "CPO, CFM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "NC",
            "license": "CPO03814",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "NC",
            "license": "CPO03814",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0482P",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9190511",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "384410",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7701327",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eliz City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.