Active NPI
Douglas J Kimmel, MD
- Diagnostic Radiology Physician
- Aberdeen, SD
National Provider Identifier
1922044239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 3940
- Practice address
- 305 S State St
Aberdeen, SD 57401-4527 - Phone
- (605) 622-5000
- NPI assigned
- Jun 22, 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 3940 | SD | Primary |
Addresses
Primary practice location
305 S State St
Aberdeen, SD 57401-4527
Mailing address
24 2ND Ave SW
Aberdeen, SD 57401-4115
Phone (605) 725-2560
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21258 | Other | ND | BCBS |
| 18453 | Medicaid | ND | |
| 7201012 | Medicaid | SD | |
| 0008378 | Other | SD | BCBS |
| 099816800 | Medicaid | MN |
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 |
|---|---|---|---|
| 6688 | ND | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera St. Luke'S | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Diagnostic Radiology Physician
- Aberdeen, SD
- NPI 1437192721
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1922044239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 2ND AVE SW",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "574014115",
"telephone_number": "605-725-2560",
"fax_number": "605-725-8782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 S STATE ST",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "574014527",
"telephone_number": "605-622-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMMEL",
"first_name": "DOUGLAS",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "SD",
"license": "3940",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "21258",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18453",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7201012",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0008378",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "099816800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aberdeen, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.