NPIMap

Individual provider Active NPI

Kimberly Staudt, MD

  • Internal Medicine Physician
  • Clarksville, IN
National Provider Identifier
1891229704
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01091586A Issued in IN
Practice address
2051 Clevidence Blvd Ste B
Clarksville, IN 47129-2278
Phone
(812) 280-9145
Fax
(812) 280-6632
NPI assigned
Apr 18, 2017
Last updated
Aug 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101266296 VA
Internal Medicine Physician 207R00000X 59573 KY
Internal Medicine Physician 207R00000X 01091586A IN Primary

Addresses

Primary practice location

2051 Clevidence Blvd Ste B
Clarksville, IN 47129-2278

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Other practice location 1

Blanchfield Army Community Hospital
650 Joel Drive
Ft. Campbell, KY 42223
Phone (270) 798-8400

Other practice location 2

Internal Medicine Walter Reed Ctr
8901 Wisconsin Avenue
Bethesda, MD 20889-0001
Phone (301) 319-0451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240517000260 IN Practitioner - Internal Medicine 2860814084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Louisville School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

2051 Clevidence Blvd
Suite B
Clarksville, IN 47129-2278
Phone (812) 280-9145

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01091586AINMDInternal Medicine Physician
59573KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Internal Medicine CurrentSince Jun 21, 2024 Accepting new patients
Community Medical Associates, Inc. Internal Medicine CurrentSince Jun 21, 2024 Accepting new patients
Community Medical Associates, Inc. Past Accepting new patients

Locations

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

2051 Clevidence Blvd
Ste B
Clarksville, IN 47129
Phone (502) 629-2030

1373 E State Road 62
#6F
Madison, IN 47250
Phone (502) 629-7181

Interoperability endpoints

  • Direct secure messaging: kstaudt291959@direct.nortonhealthcare.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1891229704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 CLEVIDENCE BLVD STE B",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471292278",
            "telephone_number": "812-280-9145",
            "fax_number": "812-280-6632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Blanchfield Army Community Hospital",
            "address_2": "650 Joel Drive",
            "address_purpose": "LOCATION",
            "city": "Ft. Campbell",
            "state": "KY",
            "postal_code": "42223",
            "country_code": "US",
            "telephone_number": "270-798-8400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Internal Medicine Walter Reed Ctr",
            "address_2": "8901 Wisconsin Avenue",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208890001",
            "country_code": "US",
            "telephone_number": "301-319-0451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAUDT",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-18",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101266296",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "59573",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01091586A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, IN

Sources for this page

Verify at the official NPI Registry.