NPIMap

Individual provider Active NPI

Kimberly Grant Mansell, DO

  • Emergency Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1952352239
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A-1350-06 Issued in NM
Practice address
2500 Harbor Blvd
Port Charlotte, FL 33952-5000
Phone
(941) 625-4155
Fax
(941) 625-4155
NPI assigned
May 12, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A-1350-06 NM Primary

Addresses

Primary practice location

2500 Harbor Blvd
Port Charlotte, FL 33952-5000

Mailing address

PO Box 510209
Punta Gorda, FL 33951-0209
Phone (941) 347-8317

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20070208000516 FL Practitioner - Emergency Medicine 8729015359 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Radiology Services LLC CurrentSince Aug 1, 2023 Accepting new patients
Solantic/South Florida, LLC CurrentSince Feb 1, 2020 Accepting new patients
Em Alliance LLC Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
Port Charlotte Hma Physician Management LLC Family Medicine PastSince Aug 1, 2007 Accepting new patients
St. Joseph Emergency Medical Physicians PA Emergency Medicine Past Accepting new patients
Mercy Clinic Joplin LLC Family Medicine Past Accepting new patients
Quentin N Burdick Comprehensive Health Care Facility Past Accepting new patients
Sjmgroup Past Accepting new patients
Port Charlotte Hma Physician Management LLC Past Accepting new patients
Rosebud Indian Health Service Past Accepting new patients
Dolphin Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Florida Em-I Medical Services PA Emergency Medicine Past Accepting new patients

Locations

5506 14th St W
Bradenton, FL 34207
Phone (941) 745-7372

18203 Pines Blvd
Pembroke Pines, FL 33029
Phone (954) 889-5823

9035 Pines Blvd
Pembroke Pines, FL 33024
Phone (954) 340-5881

10101 Forest Hill Blvd
West Palm Beach, FL 33414
Phone (561) 766-1301

1155 S Congress Ave
Ste C
West Palm Beach, FL 33406
Phone 5617661300501

16750 Persimmon Blvd
Westlake, FL 33470
Phone (561) 791-7200

7 Easton Oval
#L4387
Columbus, OH 43219

Organizations & group practices 12

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952352239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 510209",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339510209",
            "telephone_number": "941-347-8317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 HARBOR BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525000",
            "telephone_number": "941-625-4155",
            "fax_number": "941-625-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSELL",
        "first_name": "KIMBERLY",
        "middle_name": "GRANT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "A-1350-06",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.