Individual provider Active NPI

Kimberly Deem

  • Family Nurse Practitioner
  • Canton, OH
National Provider Identifier
1942684931
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
17511 Issued in OH
Practice address
7292 Fulton Dr NW
Canton, OH 44718-1525
Phone
(330) 837-3095
NPI assigned
Jul 20, 2015
Last updated
Aug 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 17511 OH Primary

Addresses

Primary practice location

7292 Fulton Dr NW
Canton, OH 44718-1525

Mailing address

7292 Fulton Dr NW
Canton, OH 44718-1525
Phone (330) 837-3095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150811005009 OH Practitioner - Nurse Practitioner 4587979174 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic Diagnostic of Ohio LLCGroup PAC ID 2961425608, 192 clinicians

Practice addresses (Care Compare)

7292 Fulton Dr NW
Canton, OH 44718-1525
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17511OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Primary Care Ohio LLC Family CurrentSince Aug 1, 2025 Accepting new patients
City of Canton Current Accepting new patients
City of Canton Current Accepting new patients
Minuteclinic Diagnostic of Ohio LLC Family CurrentSince Mar 14, 2016 Accepting new patients

Locations

7292 Fulton Dr NW
Canton, OH 44718
Phone (330) 837-3095

4961 Roberts Rd
Hilliard, OH 43026
Phone (614) 850-2407

1100 Hill Rd N
Pickerington, OH 43147
Phone (614) 579-6173

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1942684931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7292 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447181525",
            "telephone_number": "330-837-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7292 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447181525",
            "telephone_number": "330-837-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEEM",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "17511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.