Active NPI
Kismet Baldwin, M.D.
- Public Health & General Preventive Medicine Physician
- Stockton, CA
National Provider Identifier
1760674527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- A111522
- Practice address
- 1601 E Hazelton Ave
Stockton, CA 95205-6229 - Phone
- (209) 468-3411
- Fax
- (209) 468-3823
- NPI assigned
- Aug 15, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | P21929 | MD | |
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 16893 | NH | |
| Public Health & General Preventive Medicine Physician | 2083P0901X | A111522 | CA | Primary |
Addresses
Primary practice location
1601 E Hazelton Ave
Stockton, CA 95205-6229
Mailing address
1601 E Hazelton Ave
Stockton, CA 95205-6229
Phone (209) 468-3411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3099506 | Medicaid | NH |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P21929 | MD | MD | Pediatrics Physician |
| 16893 | NH | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elliot Professional Services | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557187200000",
"number": "1760674527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 E HAZELTON AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952056229",
"telephone_number": "209-468-3411",
"fax_number": "209-468-3823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 E HAZELTON AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952056229",
"telephone_number": "209-468-3411",
"fax_number": "209-468-3823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALDWIN",
"first_name": "KISMET",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-15",
"last_updated": "2019-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "P21929",
"primary": false
},
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "NH",
"license": "16893",
"primary": false
},
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "CA",
"license": "A111522",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3099506",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.