Active NPI
Stephen Michael Kimbrough, MD
- Neurology Physician
- Johnson City, TN
National Provider Identifier
1851345235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MD012583
- Practice address
- 1321 Sunset Drive
Suite 11
Johnson City, TN 37604-7902 - Phone
- (423) 928-6174
- Fax
- (423) 926-2258
- NPI assigned
- May 20, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | MD012583 | TN | Primary |
Addresses
Primary practice location
1321 Sunset Drive
Suite 11
Johnson City, TN 37604-7902
Mailing address
1321 Sunset Drive
Suite 11
Johnson City, TN 37604-7902
Phone (423) 928-6174
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100027216 | Other | PHP CARITEN TENNCARE | |
| 1292658 | Other | UMWA | |
| A55605 | Other | JOHN DEERE | |
| 026086900 | Other | BLACK LUNG COAL MINERS | |
| 130014283 | Other | UNITED HEALTHCARE | |
| 3180257 | Medicaid | TN | |
| 602003807 | Other | PHP CARITEN | |
| 0140000838 | Other | CIGNA | |
| 164888600 | Other | OWCP DEPT OF LABOR | |
| 006190821 | Medicaid | VA | |
| 0014824 | Other | TN | BCBS |
| 130014283 | Other | RR MEDICARE | |
| 027897 | Other | GM RETIREES | |
| 7905920 | Medicaid | NC | |
| 05920 | Other | NC | NC STATE |
| 64796949 | Medicaid | KY |
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 |
|---|---|---|---|
| MD012583 | TN | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457395200000",
"number": "1851345235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 SUNSET DRIVE",
"address_2": "SUITE 11",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376047902",
"telephone_number": "423-928-6174",
"fax_number": "423-926-2258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1321 SUNSET DRIVE",
"address_2": "SUITE 11",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376047902",
"telephone_number": "423-928-6174",
"fax_number": "423-926-2258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBROUGH",
"first_name": "STEPHEN",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-20",
"last_updated": "2016-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TN",
"license": "MD012583",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP CARITEN TENNCARE",
"identifier": "100027216",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1292658",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "A55605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLACK LUNG COAL MINERS",
"identifier": "026086900",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "130014283",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3180257",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP CARITEN",
"identifier": "602003807",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0140000838",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP DEPT OF LABOR",
"identifier": "164888600",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "006190821",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0014824",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "130014283",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GM RETIREES",
"identifier": "027897",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7905920",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC STATE",
"identifier": "05920",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64796949",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.