Kimberly J Prough, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9104973 Issued in FL

Practice address

2254 Highway A1A
Indian Harbour Beach, FL 32937-4922

Phone

(321) 777-2273

Fax

(321) 779-7425

NPI assigned

Jul 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Emergency Physicians of Naples PLLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1861410656
  NPD (past)
• Terra Ceia Emergency Physicians LLC

  • Emergency Medicine Physician
  • Sun City Center, FL
  • NPI 1184940843
  NPD (past)
• Denton Erdocs PA

  • Nurse Practitioner
  • Denton, TX
  • NPI 1295780906

  Physician Assistant

  NPD (past)
• Republic Emergency Services PA

  • Emergency Medicine Physician
  • Sherman, TX
  • NPI 1104875624

  Physician Assistant

  NPD (past)
• Republic Hospitalists Services PLLC

  • Internal Medicine Physician
  • Sherman, TX
  • NPI 1386689255
  NPD (past)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1902811698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2254 HIGHWAY A1A",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374922",
            "telephone_number": "321-777-2273",
            "fax_number": "321-779-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2254 HIGHWAY A1A",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374922",
            "telephone_number": "321-777-2273",
            "fax_number": "321-779-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROUGH",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104973",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02977",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "8N8636",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8Y0826",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Piakis, LDO
• Brian Kelly Pogue, DPT
• Kevin Poulston, DC
• Kelly A. Prete
• Professional Dental Alliance of Beachside, PLLC
• Publix Super Markets Inc
• William Quinn, LMT
• Allysen Rainier, PT, DPT
• Jessica Diane Rassmann, PT, DPT
• Jennifer Rathgeber, CCC-SLP

• Physician Assistant in Indian Harbour Beach, FL
• Providers in Indian Harbour Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.