MS. KIMBERLY ROSE KENSETH CRNP
NPI 1528579513
Nurse Practitioner in Pittsburgh, PA

NPI Status: Active since October 17, 2017

Contact Information

6023 HARVARD ST
PITTSBURGH, PA
ZIP 15206
Phone: (412) 661-2802
Fax: (412) 661-8020

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Physician Visit Costs
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Nurse Practitioner
Accepts Insurance
PECOS Enrolled
Opted-Out Medicare

About KIMBERLY KENSETH

This page provides the complete NPI Profile along with additional information for Kimberly Kenseth, a provider established in Pittsburgh, Pennsylvania with a medical specialization in Nurse Practitioner. The healthcare provider is registered in the NPI registry with number 1528579513 assigned on October 2017. The practitioner's primary taxonomy code is 363L00000X with license number SP017995 (PA). The provider is registered as an individual and her NPI record was last updated 9 years ago.

NPI: 1528579513
Provider Name: MS. KIMBERLY ROSE KENSETH CRNP
Gender: Female
Entity Type: Individual
Location Address: 6023 HARVARD ST PITTSBURGH, PA 15206
Location Phone: (412) 661-2802
Location Fax: (412) 661-8020
Mailing Address: 6023 HARVARD ST PITTSBURGH, PA 15206
Mailing Phone: (412) 661-2802
Mailing Fax: (412) 661-8020
Is Sole Proprietor?: No
Enumeration Date: 10-17-2017
Last Update Date: 10-17-2017
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A nurse practitioner (NP) like Kimberly Kenseth is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Kimberly Kenseth opted out of Medicare effective on 01-01-2019 until 01-01-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Nurse Practitioner
Taxonomy Code: 363L00000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: SP017995
License State: PA
Taxonomy Description: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Highmark Blue Cross Blue Shield West Virginia

my Blue Access WV Major Events PPO Catastrophic 10600 - 3 Free PCP Visits - PPO
my Blue Access WV PPO Bronze 3800 - PPO
my Blue Access WV PPO Bronze 3800 + Adult Dental and Vision - PPO
my Blue Access WV PPO Bronze 9200 - PPO
my Blue Access WV PPO Gold 0 - PPO
my Blue Access WV PPO Gold 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Gold 1700 HSA - PPO
my Blue Access WV PPO Premier Gold 0 - PPO
my Blue Access WV PPO Premier Gold 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Premier Silver 0 - PPO
my Blue Access WV PPO Premier Silver 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Standard Bronze 7500 - PPO
my Blue Access WV PPO Standard Gold 2000 - PPO
my Blue Access WV PPO Standard Gold 2000 + Adult Dental and Vision - PPO
my Blue Access WV PPO Standard Silver 6000 - PPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Kimberly Kenseth is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 01-01-2019
Opt-Out End Date: 01-01-2027
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 15206 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $84.88
Minimum New Patient Price $54.64
Maximum New Patient Price $166.87

Average New Patient Copayment $21.22
Minimum New Patient Copayment $13.66
Maximum New Patient Copayment $41.71

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $96.82
Minimum Established Patient Price $17.33
Maximum Established Patient Price $135.84

Average Established Patient Copayment $24.2
Minimum Established Patient Copayment $4.33
Maximum Established Patient Copayment $33.96

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1528579513, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 4

Pos 4

Unchanged

Pos 5

Doubled → 10 → 1 + 0

Pos 6

Unchanged

Pos 7

Doubled → 18 → 1 + 8

Pos 8

Unchanged

Pos 9

Doubled → 2

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 2 → 4 5 → 10 → 1 9 → 18 → 9 1 → 2

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 5 + 4 + 8 + 1 + 0 + 7 + 1 + 8 + 5 + 2 + 24 = 67

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 67 is 70. The difference is the calculated check digit.

70 - 67 = 3

This NPI is valid

The calculated check digit is 3, which matches the last digit of 1528579513.