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DR. KIMBERLY ROSE COUGHLIN MD
NPI 1356791636
Surgery in Saint Clair Shores, MI

Active since June 16, 2016PECOS EnrolledAccepts Medicare Assignment
83.35/100
CMS Quality Rating
29000 LITTLE MACK AVE STE B, SAINT CLAIR SHORES, MI 48081(586) 774-8811(586) 541-0199 Get Directions Write a Review

NPPES record last updated: June 21, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 16, 2021, Jun 16, 2016 (2 updates tracked since 2016).

About Dr. Kimberly Rose Coughlin Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KIMBERLY ROSE COUGHLIN MD (NPI 1356791636) is an individual surgery provider in Saint Clair Shores, Michigan, licensed in Michigan (4301506652) and active in the NPI registry since June 2016. She is enrolled in Medicare PECOS, is affiliated with Ascension St John Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1356791636
Entity TypeIndividualFemale
Primary Taxonomy208600000X
Provider Legal NameDR. KIMBERLY ROSE COUGHLINCredential: MD
Location Address29000 LITTLE MACK AVE STE BSaint Clair Shores, MI 48081-3018
Mailing Address22101 Moross RdDetroit, MI 48236-2148
Phone(586) 774-8811
Fax(586) 541-0199
Sole ProprietorNo
Medical School CMSWayne State University School Of MedicineGraduated 2016
Enumeration DateJune 16, 2016
Last NPPES UpdateJune 21, 20222 updates tracked since enumeration
NPPES CertifiedJune 21, 2022
✔ NPI 1356791636 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
Licenses✔ Licensed in MI · 4301506652✔ Licensed in NY · 309316
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License 4301109635 (MI)
29000 LITTLE MACK AVE STE B, Saint Clair Shores, MI 48081
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1161 Fort Washington Ave Fl 8New York, NY 10032-3729 · Phone (212) 305-0519
Location 222101 Moross RdDetroit, MI 48236-2148 · Phone (313) 343-3878

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kimberly Rose Coughlin Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7810288834
PECOS Enrollment IDI20220630002197
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
47 services32 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
28 services28 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
20 services20 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
16 services16 patients
Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221
Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.
16 services16 patients
Repair of groin hernia using an endoscope 49650
This procedure involves the use of an endoscope, a thin tube with a camera, to repair a hernia in the groin area. The surgeon makes small incisions, inserts the endoscope, and uses special tools to fix the hernia. This minimally invasive technique often results in quicker recovery times.
12 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ascension St John Hospital

Acute Care Hospitals · Detroit, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number230165
Location22101 Moross RdDetroit, MI 48236 · Wayne County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48081 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$72.38 typical visit price
range $18.32 – $143.49
Typical copayment $18.09 (range $4.58 – $35.87)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.35/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality68.06
Promoting Interoperability100
Improvement Activities40
Cost60.61

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAREN L. SUMME MD
Surgery
29000 LITTLE MACK AVE STE B
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 774-8811
MOUTAMN SADOUN M.D.
Surgery
29000 LITTLE MACK AVE STE B
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 774-8811
SHOSHANA DEANN HALLOWELL M.D.
Surgery
29000 LITTLE MACK AVE STE B
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 774-8811
CHRISTOPHER E LAI M.D.
Surgery
29000 LITTLE MACK AVE STE B
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 774-8811

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Coughlin's NPI number?

The NPI number for Kimberly Coughlin is 1356791636. It was assigned to this individual provider in the NPPES registry on June 16, 2016.

Where is Kimberly Coughlin located?

Kimberly Coughlin practices at 29000 Little Mack Ave Ste B, Saint Clair Shores, MI 48081. The listed phone number is (586) 774-8811.

What is Kimberly Coughlin's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Kimberly Coughlin enrolled in Medicare?

Yes. Kimberly Coughlin is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kimberly Coughlin accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 2 other insurers list Kimberly Coughlin as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kimberly Coughlin affiliated with any hospitals?

According to CMS data, Kimberly Coughlin is affiliated with Ascension St John Hospital.

When was this NPI record last updated?

The NPPES record for Kimberly Coughlin was last updated on June 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.