NPIMap

Individual provider Active NPI

Kelly A Gibson, AU.D.

  • Audiologist-Hearing Aid Fitter
  • Santa Rosa, CA
National Provider Identifier
1841324860
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
AU 2679 Issued in CA
Practice address
4725 Hoen Ave
Santa Rosa, CA 95405-9402
Phone
(707) 542-1154
Fax
(707) 542-4818
NPI assigned
Mar 14, 2007
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AU 2679 CA
Assistive Technology Practitioner Audiologist 231HA2400X AU 2679 CA
Assistive Technology Supplier Audiologist 231HA2500X AU 2679 CA
Audiologist-Hearing Aid Fitter 237600000X AU 2679 CA Primary
Hearing Instrument Specialist 237700000X

Addresses

Primary practice location

4725 Hoen Ave
Santa Rosa, CA 95405-9402

Mailing address

750 N Commons Dr Ste 200
Aurora, IL 60504-7940
Phone (630) 303-5380

Other identifiers 1

IdentifierTypeStateIssuer
CB279930OtherCAMEDICARE

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

State licenses

LicenseStateTypeSpecialty
0473KYMDAddiction (Substance Use Disorder) Counselor
AU 2679CAMDAssistive Technology Supplier Audiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Connect Hearing, Inc. Audiologist PastSince Dec 28, 2022 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients
Connect Hearing, Inc. Audiologist PastSince Dec 16, 2020 Accepting new patients
Virtual Benefit Solutions Inc Audiologist Past Accepting new patients
Hearing Services of Kentucky Inc. Audiologist PastSince Dec 5, 2013 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients
Connect Hearing, Inc. Audiologist 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1841324860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N COMMONS DR STE 200",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047940",
            "telephone_number": "630-303-5380",
            "fax_number": "630-303-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954059402",
            "telephone_number": "707-542-1154",
            "fax_number": "707-542-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KELLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU 2679",
            "primary": false
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "CA",
            "license": "AU 2679",
            "primary": false
        },
        {
            "code": "231HA2500X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "CA",
            "license": "AU 2679",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CA",
            "license": "AU 2679",
            "primary": true
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CB279930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.