Jack McIntyre Kimmell

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

3925375607 Issued in IN

Practice address

1526 East Lasalle
South Bend, IN 46617

Phone

(574) 310-1911

NPI assigned

Oct 20, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1740731116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 E LASALLE AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172606",
            "telephone_number": "574-310-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 EAST LASALLE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46617",
            "telephone_number": "574-310-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMMELL",
        "first_name": "JACK",
        "middle_name": "MCINTYRE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-20",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "3925375607",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "3925375607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• C Kurtis Kim, M.D.
• Henry Kim, M.D.
• Susie Kim
• Young Bin Kim, MA
• Mercy Kimani
• Samuel Joseph Kimmell, DO
• Sara Lynn Kinas, RBT
• Jessica A Kindig, LMHC
• Cynthia Rene'a King-Harris, M.S.,L.M.H.C.
• Adriana King

• Student in an Organized Health Care Education/Training Program in South Bend, IN
• Providers in South Bend, IN by specialty
• Student in an Organized Health Care Education/Training Program in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.