Kimberly Chipetine, DO
Individual provider Active NPI Family Medicine Physician · Mesa, AZ
NPI 1922590629 · NPPES record last updated Apr 17, 2025
Key facts
- NPI
- 1922590629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 9191 (AZ)
- Practice address
- 5110 E Southern Ave Ste 105
Mesa, AZ 85206-2790 - Phone
- (480) 295-8072
- Fax
- (415) 252-7176
- NPI assigned
- May 30, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 8
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Iora Senior Health LLC
Practice addresses (Care Compare)
5110 E Southern Ave
Suite 107
Mesa, AZ 85206-2790
Phone (888) 405-6396
Hospital & facility affiliations
- Sunrise Health Services
- Banner Home Care-Arizona
- Banner Baywood Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20210908002053 | AZ | Practitioner - Family Practice | 6608121249 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9191 | AZ | MD | Family Medicine Physician |
| OT018400 | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iora Senior Health, LLC | Current |
Accepting new patients | |
| Iora Senior Health, LLC | Current |
Accepting new patients | |
| Iora Health Massachusetts, P.C. | Past | Accepting new patients | |
| Iora Health, LLC | Past | Accepting new patients | |
| Iora Senior Health, LLC | Past | Accepting new patients |
Locations
5110 E Southern Ave
Ste 107
Mesa, AZ 85206
Phone (480) 295-8072
3137 W Indian School Rd
Phoenix, AZ 85017
Phone (602) 325-5570
1 Embarcadero Ctr
Ste 1900
San Francisco, CA 94111
1 Lincoln St
Fl 24
Boston, MA 02111
101 Tremont St
Fl 6
Boston, MA 02108
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OT018400 | PA | |
| Family Medicine Physician | 207Q00000X | 9191 | AZ | Yes |
Addresses
Primary practice location
5110 E Southern Ave Ste 105
Mesa, AZ 85206-2790
Mailing address
1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723
Other providers in Mesa, AZ
- Bryce Campbell Child
- Caitlin Janae Dunbar Child
- Jeremy Roberts Child
- Danielle Chinavare
- Hezekiah Ubochi Chinwah
- Naomi R Chipley
- Chiro One Wellness Center of Mesa LLC
- Chirofit Chiropractic Group LLC
- Chiropractic Health Innovations, PLC
- Victor Chiu
All providers in Mesa, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2025. 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.