NPIMap

Individual provider Active NPI

Joel P Kimelman, DO

  • Diagnostic Radiology Physician
  • Flint, MI
National Provider Identifier
1720042674
Registry record updated Aug 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
5101005903 Issued in MI
Practice address
3346 Lennon Road
Flint, MI 48507-1015
Phone
(810) 732-1919
Fax
(810) 732-3740
NPI assigned
Apr 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X JK005903 MI
Diagnostic Radiology Physician 2085R0202X 5101005903 MI Primary

Addresses

Primary practice location

3346 Lennon Road
Flint, MI 48507-1015

Mailing address

3346 Lennon Road
Suite 2
Flint, MI 48507-1015
Phone (810) 732-1919

Other identifiers 6

IdentifierTypeStateIssuer
4398860MedicaidMI
4477536OtherMIAETNA
57100OtherMIOMNICARE
016618OtherMIMIDWEST HEALTH PLANS
136504OtherMIGREAT LAKES HEALTH PLAN
300Q264480OtherMIBCBSM/BCN

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
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
JK005903MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Macomb-Oakland Hospital Past Accepting new patients
Physicians Residential Services, P.C. Past Accepting new patients
Regional Medical Imaging, P.C. Diagnostic Radiology PastSince Dec 5, 2008 Accepting new patients
Psi Radiological Service, Inc Past Accepting new patients
Oakland Diagnostic Imaging Past Accepting new patients
Midwest Diagnostic Imaging, Inc Diagnostic Radiology PastSince Jan 1, 2006 Accepting new patients
Family Orthopedic Associates P L C Past Accepting new patients
Michigan Diagnostic Services, Inc Past Accepting new patients

Organizations & group practices 8

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": "1145059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1720042674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3346 LENNON ROAD",
            "address_2": "SUITE 2",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071015",
            "telephone_number": "810-732-1919",
            "fax_number": "810-732-3740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3346 LENNON ROAD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071015",
            "telephone_number": "810-732-1919",
            "fax_number": "810-732-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMELMAN",
        "first_name": "JOEL",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-15",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "JK005903",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101005903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4398860",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4477536",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNICARE",
            "identifier": "57100",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST HEALTH PLANS",
            "identifier": "016618",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "136504",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM/BCN",
            "identifier": "300Q264480",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

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

Verify at the official NPI Registry.