KIMBERLY CHEMACKI (NPI# 1376587584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376587584 |
| Entity Type | Individual |
| Full Name | KIMBERLY CHEMACKI |
| Credential | PA-C |
| Practice Address |
196 Parkway S Suite 103 Waterford CT 06385-1234 |
| Practice Telephone | 8604434383 |
| Practice Fax Number | 8604433980 |
| Mailing Telephone | 8604434383 |
| Mailing Fax Number | 8604433980 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2011-12-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
1019 | CT | Allopathic & Osteopathic Physicians |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
001019 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HEATHNET/ECCD:06-1616101 | 0V9729 | 01 | |
| ANTHEM/ECCG: 06-1049086 | 290001019CT01 | 01 | |
| ANTHEM/HOSP-BASED ECCD | 500HBC444CT01 | 01 | |
| RR MED/ECCD: 06-1616101 | 060064820 | 01 | |
| CONNECTICARE | 649086 | 01 | |
| OXFORD/ECCG: 06-1049086 | P2473100 | 01 | |
| BLUECARE FAMILY PLAN | 004220654 | 01 | |
| RR MED/ECCG: 06-1049086 | 970016208 | 01 | |
| OXFORD/ECCD: 06-1616101 | P2524340 | 01 | |
| HEALTHNET/ECCG:06-1049086 | 0V9728 | 01 | |
| ANTHEM/ECCD: 06-1616101 | 290001019CT03 | 01 |
| Street Address |
196 PARKWAY S SUITE 103 |
| City | WATERFORD |
| State | CT |
| Zip Code | 06385-1234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235136094 | Mithlesh Govil | Internal Medicine | 196 Parkway S, Suite 303, Waterford, CT 06385-1234 | 2005-07-07 |
| 1427431840 | Julie Zito | Physician Assistant | 196 Parkway S, Suite303, Waterford, CT 06385-1234 | 2015-07-02 |
| 1275933095 | Crossroads Primary Care, LLC | Durable Medical Equipment & Medical Supplies | 196 Parkway S, Suite 304, Waterford, CT 06385-1234 | 2014-08-28 |
| 1255745014 | Jacqueline Lagasse | Registered Nurse | 196 Parkway S, Suite 303, Waterford, CT 06385-1234 | 2014-06-19 |
| 1093140162 | Kenneth R Kierstein | Podiatrist | 196 Parkway S, Suite 302, Waterford, CT 06385-1234 | 2013-09-09 |
| 1528369006 | Carol Ann Greene | Occupational Therapy Assistant | 196 Parkway S, Suite 201, Waterford, CT 06385-1234 | 2010-11-15 |
| 1073827465 | Sarah R Donahue | Nurse Practitioner | 196 Parkway S, Suite 303, Waterford, CT 06385-1234 | 2010-07-28 |
| 1861724106 | Valmarie Ramos | Internal Medicine | 196 Parkway S, Suite 303, Waterford, CT 06385-1234 | 2010-02-11 |
| 1326279035 | Jodi V Hodge | Physician Assistant | 196 Parkway S, Suite 303, Waterford, CT 06385-1234 | 2009-07-29 |
| 1023261690 | Katherine Lm Bender | Nurse Practitioner | 196 Parkway S, Suite 304, Waterford, CT 06385-1234 | 2008-10-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073140331 | Megan Plattner | Hearing Instrument Specialist | Waterford Commons 903-915 Hartford Tpke, Store 16, Waterford, CT 06385 | 2020-03-26 |
| 1174032288 | Winakor's Healing Practice | Social Worker | 758 Broad St. Ext., Waterford, CT 06385 | 2017-09-21 |
| 1972029494 | Michael C Marshall | Social Worker | 112 Great Neck Road, Empowerment Counseling Services, LLC, Waterford, CT 06385 | 2017-08-16 |
| 1750810297 | Taylor Anne Tomasetti | Occupational Therapist | 24 Doyle Rd, Waterford, CT 06385 | 2017-06-08 |
| 1366993214 | Ascension Naturopathic Healing Center LLC | Clinic/Center | 175 Boston Post Road, Floor 1, Waterford, CT 06385 | 2016-10-16 |
| 1467815126 | Sanborn Optometric Associates | Clinic/Center | 900 Hartford-new London Turnpike, Waterford, CT 06385 | 2016-03-31 |
| 1225499007 | Martin L Hellman, Od, Faao, LLC | Optometrist | 850 Waterford Tpke, Waterford, CT 06385 | 2016-03-08 |
| 1861876211 | Mallory Rose Devona | Counselor | 2 Leary Dr, Waterford, CT 06385 | 2015-07-15 |
| 1336571843 | Carrie M Reynolds | Surgery | 5 Scenic View Dr, Waterford, CT 06385 | 2013-08-07 |
| 1194085076 | Meghana Rao Brito | Internal Medicine | 196 Waterford Pkwy S Ste 103, Waterford, CT 06385 | 2012-05-24 |
| Find all providers in zip 06385 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616687 | Alexandria Jaclyn Miller | Physician Assistant | 4700 Chipman Dr, Waterford, MI 48327-3413 | 2020-10-15 |
| 1902825243 | Jason Charles Evans | Physician Assistant | 1095 W Huron St, Waterford, MI 48328-3735 | 2006-07-18 |
| 1912541681 | Robert Oshnock | Physician Assistant | 1012 W Huron St, Waterford, MI 48328-3730 | 2019-11-05 |
| 1326279035 | Jodi V Hodge | Physician Assistant | 196 Parkway S, Suite 303, Waterford, CT 06385-1234 | 2009-07-29 |
| 1053572933 | Jaia Sojka | Physician Assistant | 818 Forrest Dr, Waterford, WI 53185-4577 | 2008-06-23 |
| 1770691073 | Michael Belitz | Physician Assistant | 7092 Highland Rd, Waterford, MI 48327-1502 | 2006-08-27 |
| 1437104189 | James C Combs | Physician Assistant | 1305 N Oakland Blvd, Er Department, Waterford, MI 48327 | 2006-05-23 |
| 1255386900 | Scott C Bonzheim | Physician Assistant | 1305 N Oakland Blvd, Er Department, Waterford, MI 48327 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578163671 | Kirsten Alexandra Drobiak | Physician Assistant | 37 Jennifer Ln, Griswold, CT 06351-3500 | 2020-10-28 |
| 1255955019 | Amanda Uscilla | Physician Assistant | 20 Hilltop Rd, Bethany, CT 06524-3514 | 2020-06-07 |
| 1689208571 | Sage Ann Miele | Physician Assistant | 149 Water St Apt 32, Norwalk, CT 06854-3758 | 2020-02-28 |
| 1790319655 | Erin Kelly Flynn | Physician Assistant | 464 Congress Ave # Suie260, New Haven, CT 06519-1361 | 2020-02-28 |
| 1659919702 | Jeniece Kayla Wert | Physician Assistant | 100 Church Street South, Suite A230 Room A235, New Haven, CT 06519-1703 | 2019-12-18 |
| 1811547508 | Gabriela M Vargas | Physician Assistant | 24 Hospital Ave # Tower7, Danbury, CT 06810-6099 | 2019-09-16 |
| 1275192049 | Molly J Mable | Physician Assistant | 282 Washington St Fl 1, Hartford, CT 06106-3322 | 2019-06-06 |
| 1003377631 | Stephan Anton Bayer | Physician Assistant | 205 Elm St Apt 5, West Haven, CT 06516-4659 | 2019-03-27 |
| 1578024105 | Vance P Baughman | Physician Assistant | 325 Lafayette St Unit 1003, Bridgeport, CT 06604-5472 | 2019-03-27 |
| 1588121354 | Jason Michael Nies | Physician Assistant | 20 York St # 218, New Haven, CT 06510-3220 | 2019-02-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.