Kimberly A Hegewald, MD

Key facts

NPI

1851379770

Entity type

Individual (NPI type 1)

Primary specialty

Pediatrics Physician 208000000X

License

4301075523 (MI)

Practice address

3537 W Front St Ste G
Traverse City, MI 49684-7943

Phone

(231) 935-8822

NPI assigned

Jan 3, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Kids Creek Childrens Clinic PC Pediatrics Physician · Traverse City, MI · NPI 1649291832
  Medicare reassignment NPD MI · PEDIATRICS
• Grand Traverse Children'S Clinic Pediatrics Physician · Traverse City, MI · NPI 1750398871
  NPD (past) PEDIATRICS
• Munson Medical Center General Acute Care Hospital · Traverse City, MI · NPI 1952307852
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBICCA
• Direct secure messaging: kimberly.hegewald@kccc.eclinicaldirectplus.com

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 21, 2020.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1851379770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 W FRONT ST STE G",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3537 W FRONT ST STE G",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847943",
            "telephone_number": "231-935-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEGEWALD",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301075523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4290606",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kimberly.Hegewald@kccc.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "5024 N Royal Dr",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496849230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

• Zachary Hector-Word, MD
• Heeren Family Therapy
• Allison B Heeren, MSW
• Roy Charles Heeren, LMSW, ACSW
• Brian D Heeringa, MD
• Montgomery John Hegewald, M.D.
• Sarah Paulina Hegg, LLP
• Robin A Heiges, MSW
• Joseph M Heiler, M.P.T.
• David Heimburger, MD

All providers in Traverse City, MI · Pediatrics Physician in Michigan