Active NPI
Elizabeth L Kimbrough, MD
- Internal Medicine Physician
- Oshkosh, WI
National Provider Identifier
1750366704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 42248
- Practice address
- 491 S Washburn St
Suite 100
Oshkosh, WI 54904-6733 - Phone
- (920) 292-5555
- Fax
- (920) 292-1717
- NPI assigned
- Dec 13, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 42248 | WI | Primary |
Addresses
Primary practice location
491 S Washburn St
Suite 100
Oshkosh, WI 54904-6733
Mailing address
3232 N Ballard Rd
Appleton
Appleton, WI 54911-8804
Phone (920) 749-9668
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13124 | Other | WI | DEAN |
| WI01A2 | Other | WI | JOHN DEERE |
| 110232655 | Other | WI | RAILROAD MEDICARE |
| 390807236YY | Other | WI | UNITY |
| 33345700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42248 | WI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469059200000",
"number": "1750366704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3232 N BALLARD RD",
"address_2": "APPLETON",
"city": "APPLETON",
"state": "WI",
"postal_code": "549118804",
"telephone_number": "920-749-9668",
"fax_number": "920-734-5307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "491 S WASHBURN ST",
"address_2": "SUITE 100",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549046733",
"telephone_number": "920-292-5555",
"fax_number": "920-292-1717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBROUGH",
"first_name": "ELIZABETH",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-13",
"last_updated": "2016-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "42248",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN",
"identifier": "13124",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "WI01A2",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110232655",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITY",
"identifier": "390807236YY",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33345700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.