NPIMap

Individual provider Active NPI

Kimberly Kone Ellis, M.D.

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1700220936
Registry record updated Feb 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q9179 Issued in TX
Practice address
3939 Medical Dr
Ste 100
San Antonio, TX 78229-2291
Phone
(210) 450-6120
Fax
(210) 450-6161
NPI assigned
Apr 18, 2013
Last updated
Feb 5, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Q9179 TX Primary

Addresses

Primary practice location

3939 Medical Dr
Ste 100
San Antonio, TX 78229-2291

Mailing address

3939 Medical Dr Ste 100
San Antonio, TX 78229-2292
Phone (210) 450-6120

Other identifiers 2

IdentifierTypeStateIssuer
362107001MedicaidTX
362107002OtherTXCSHCN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20160810000209 TX Practitioner - Family Practice 6709170012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3939 Medical Dr
San Antonio, TX 78229-2291
Phone (210) 450-9000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q9179TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Health Science Center at San Antonio CurrentSince Aug 15, 2016 Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince Aug 15, 2016 Accepting new patients
University of Texas Health Science Center at San Antonio Family Medicine Current Accepting new patients
University of Texas Health Science Center at San Antonio Past Accepting new patients

Locations

3939 Medical Dr
San Antonio, TX 78229
Phone (210) 450-6120

3939 Medical Dr
Ste 100
San Antonio, TX 78229
Phone (210) 450-6120

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 567-6405

Interoperability endpoints

  • Direct secure messaging: kkone25027@direct.utmsa.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1700220936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 MEDICAL DR STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292292",
            "telephone_number": "210-450-6120",
            "fax_number": "210-450-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 MEDICAL DR",
            "address_2": "STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292291",
            "telephone_number": "210-450-6120",
            "fax_number": "210-450-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KIMBERLY",
        "middle_name": "KONE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-18",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q9179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362107001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "362107002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.