Individual provider Active NPI

Kimberly K Edwards, PA-C

  • Physician Assistant
  • Fort Thomas, KY
National Provider Identifier
1740616010
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2473 Issued in KY
Practice address
85 N Grand Ave
Fort Thomas, KY 41075-1793
Phone
(859) 572-3618
Fax
(859) 572-2326
NPI assigned
Sep 18, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10003082A IN
Physician Assistant 363A00000X 003842 OH
Physician Assistant 363A00000X PA2473 KY Primary

Addresses

Primary practice location

85 N Grand Ave
Fort Thomas, KY 41075-1793

Mailing address

PO Box 18667
Erlanger, KY 41018-0667
Phone (513) 312-2247

Other practice location 1

4900 Houston Rd
Florence, KY 41042-4824
Phone (859) 212-5441

Other practice location 2

600 Wilson Creek Rd
Lawrenceburg, IN 47025-2751
Phone (812) 537-1010

Other practice location 3

1640 Flossie Dr
Greendale, IN 47025-8424
Phone (812) 496-3285

Other identifiers 3

IdentifierTypeStateIssuer
0093322MedicaidOH
7100603110MedicaidKY
300044877MedicaidIN

Other names 1

  • Kimberly K Bauer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190715002468 KY Practitioner - Physician Assistant 6507092640 Reassigns benefits to 1 organization
I20201110001905 IN Practitioner - Physician Assistant 6507092640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, shared by 11 NPIs, 803 clinicians

Practice addresses (Care Compare)

1400 Grand Ave
Newport, KY 41071-2570
Phone (859) 301-5901

1640 Flossie Dr
Greendale, IN 47025-8424
Phone (855) 277-4230

2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone (859) 301-5901

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.13 of 100Reported as group
Quality
89.38
Improvement activities
40
Cost
79.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10003082AINMDPhysician Assistant
003842OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Summit Medical Group, Inc Physician Assistant CurrentSince Jul 8, 2024 Accepting new patients
Summit Medical Group, Inc Physician Assistant CurrentSince Jul 8, 2024 Accepting new patients

Locations

204 Bridgeway St
Aurora, IN 47001
Phone (812) 926-3133

1640 Flossie Dr
Lawrenceburg, IN 47025
Phone (812) 496-3285

600 Wilson Creek Rd
Lawrenceburg, IN 47025
Phone (812) 532-2700

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

85 N Grand Ave
Fort Thomas, KY 41075
Phone (859) 572-3100

1400 Grand Ave
Newport, KY 41071
Phone (859) 905-3070

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

1 Medical Center Dr
Middletown, OH 45005
Phone (513) 424-2111

Interoperability endpoints

  • Direct secure messaging: kedwards288888@direct-prd.stelizabeth.com

Organizations & group practices 3

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 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": "1379462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1740616010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18667",
            "city": "ERLANGER",
            "state": "KY",
            "postal_code": "410180667",
            "telephone_number": "513-312-2247",
            "fax_number": "859-572-2326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 N GRAND AVE",
            "city": "FORT THOMAS",
            "state": "KY",
            "postal_code": "410751793",
            "telephone_number": "859-572-3618",
            "fax_number": "859-572-2326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4900 Houston Rd",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "KY",
            "postal_code": "410424824",
            "country_code": "US",
            "telephone_number": "859-212-5441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Wilson Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Lawrenceburg",
            "state": "IN",
            "postal_code": "470252751",
            "country_code": "US",
            "telephone_number": "812-537-1010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1640 Flossie Dr",
            "address_purpose": "LOCATION",
            "city": "Greendale",
            "state": "IN",
            "postal_code": "470258424",
            "country_code": "US",
            "telephone_number": "812-496-3285",
            "fax_number": "812-537-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KIMBERLY",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-18",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003082A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "003842",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0093322",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100603110",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300044877",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BAUER",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Thomas, KY

Sources for this page

Verify at the official NPI Registry.