NPIMap

Individual provider Active NPI

Kimberly Dessources

  • Gynecologic Oncology Physician
  • Raleigh, NC
National Provider Identifier
1922402064
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
2022-02157 Issued in NC
Practice address
2901 Blue Ridge Rd Ste 200
Raleigh, NC 27607-6423
Phone
(919) 784-6875
NPI assigned
Oct 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gynecologic Oncology Physician 207VX0201X 2022-02157 NC Primary

Addresses

Primary practice location

2901 Blue Ridge Rd Ste 200
Raleigh, NC 27607-6423

Mailing address

757 Westwood PLZ
Room B713 Rrucla
Los Angeles, CA 90095-8358

Other practice location 1

757 Westwood Plz
Room B713 RRUCLA
Los Angeles, CA 90095-8358
Phone (310) 825-8307

Other practice location 2

101 Manning Dr
Chapel Hill, NC 27514-4220
Phone (984) 974-1000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kdessources878898@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20221025003515 NC Practitioner - Gynecological Oncology 4284000688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gynecological Oncology
Education
Columbia University College of Physicians and Surgeons, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of North Carolina at Chapel Hill 2,028 clinicians

Practice addresses (Care Compare)

101 Manning Dr
Chapel Hill, NC 27514-4220
Phone (984) 974-1000

Hospital & facility affiliations

  • Unc Hospitals Hospital, Chapel Hill, NC, CCN 340061
  • Rex Hospital Hospital, Raleigh, NC, CCN 340114
  • Unc Health Nash Hospital, Rocky Mount, NC, CCN 340147

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rex Hospital Inc CurrentSince Oct 6, 2022 Accepting new patients
University of North Carolina at Chapel Hill CurrentSince Oct 6, 2022 Accepting new patients
Rex Hospital Inc Current Accepting new patients
Rex Hospital, Inc CurrentSince Oct 6, 2022 Accepting new patients
University of North Carolina at Chapel Hill CurrentSince Oct 6, 2022 Accepting new patients
Park Ophthalmology Past Accepting new patients

Locations

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

430 Waterstone Dr
Hillsborough, NC 27278
Phone (984) 215-2000

5221 Paramount Pkwy
Ste 420
Morrisville, NC 27560
Phone (984) 215-6533

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

2901 Blue Ridge Rd
Raleigh, NC 27607
Phone (919) 784-3105

2901 Blue Ridge Rd
Ste 200
Raleigh, NC 27607
Phone (919) 784-6818

Interoperability endpoints

  • Direct secure messaging: kdessources878898@direct.unc.nchie.net

Organizations & group practices 11

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1922402064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLZ",
            "address_2": "ROOM B713 RRUCLA",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 BLUE RIDGE RD STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076423",
            "telephone_number": "919-784-6875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "757 Westwood Plz",
            "address_2": "Room B713 RRUCLA",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900958358",
            "country_code": "US",
            "telephone_number": "310-825-8307",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Manning Dr",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275144220",
            "country_code": "US",
            "telephone_number": "984-974-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESSOURCES",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-17",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NC",
            "license": "2022-02157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdessources878898@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2901 Blue Ridge Rd Ste 200",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276076423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.