Kimberly Kongkasuwan, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Alexandria, VA
NPI 1871661249 · NPPES record last updated Mar 29, 2013
Key facts
- NPI
- 1871661249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 0101102794 (VA)
- Practice address
- 4660 Kenmore Ave
Alexandria, VA 22304-1313 - Phone
- (703) 370-4300
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- West Virginia University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Physician and Midwife Collaborative Practice
Maryland Physicians Edge LLC
Practice addresses (Care Compare)
12508 Lake Ridge Dr
Lake Ridge, VA 22192-2354
Phone (703) 370-4300
2616 Sherwood Hall LN
Suite 208
Alexandria, VA 22306-3154
Phone (703) 780-6900
4660 Kenmore Ave
Suite 902
Alexandria, VA 22304-1306
Phone (703) 370-4300
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.06 of 100
- Quality
- 82.04
- Improvement activities
- 40
- Cost
- 70.83
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in DC, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070827000802 | DC | Practitioner - Obstetrics/Gynecology | 2062488125 | Reassigns benefits to 2 organizations |
| I20210219000898 | VA | Practitioner - Obstetrics/Gynecology | 2062488125 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101102794 | VA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Physician and Midwife Collaborative Practice | Obstetrics & Gynecology | Current | Accepting new patients |
| The Physician and Midwife Collaborative Practice | Obstetrics & Gynecology | Current |
Accepting new patients |
Locations
2616 Sherwood Hall Ln
Ste 208
Alexandria, VA 22306
Phone (703) 780-6900
4660 Kenmore Ave
Ste 902
Alexandria, VA 22304
Phone (703) 370-4300
5901 Kingstowne Village Pkwy
Ste 200
Alexandria, VA 22315
Phone (703) 370-4300
3803 Fairfax Dr
Ste 500
Arlington, VA 22203
Phone (703) 842-0602
12508 Lake Ridge Dr
Woodbridge, VA 22192
Phone (703) 370-4300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 0101102794 | VA | Yes |
Addresses
Primary practice location
4660 Kenmore Ave
Alexandria, VA 22304-1313
Mailing address
4660 Kenmore Ave
Suite 902
Alexandria, VA 22304-1313
Phone (703) 370-4300
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- David Alan Kon
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All providers in Alexandria, VA · Obstetrics & Gynecology Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.