Active NPI
Kimberly Patricia Brathwaite, M.D.
- Pediatrics Physician
- South Bend, IN
National Provider Identifier
1982916359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35121890
- Practice address
- 615 N Michigan St
Newborn ICU
South Bend, IN 46601-1033 - Phone
- (574) 647-1000
- NPI assigned
- Jul 13, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35121890 | OH | Primary |
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 01076050A | IN |
Addresses
Primary practice location
615 N Michigan St
Newborn ICU
South Bend, IN 46601-1033
Mailing address
615 N Michigan St
Newborn ICU
South Bend, IN 46601-1033
Phone (574) 647-1000
Other names 1
- Dr. Kimberly Patricia Carpenter
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 |
|---|---|---|---|
| 35121890 | OH | MD | Pediatrics Physician |
| 01076050A | IN | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital of South Bend | 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.
-
- General Acute Care Hospital
- South Bend, IN
- NPI 1295772093
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468454400000",
"number": "1982916359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 N MICHIGAN ST",
"address_2": "NEWBORN ICU",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011033",
"telephone_number": "574-647-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 N MICHIGAN ST",
"address_2": "NEWBORN ICU",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011033",
"telephone_number": "574-647-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRATHWAITE",
"first_name": "KIMBERLY",
"middle_name": "PATRICIA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-13",
"last_updated": "2016-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35121890",
"primary": true
},
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "IN",
"license": "01076050A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "CARPENTER",
"middle_name": "PATRICIA",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.