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Kimberly K Hissong

Anesthesiology

Allopathic & Osteopathic Physicians

3315 Watt Ave, Sacramento, CA 95821-3600

PECOS Enrollment

This provider is enrolled in PECOS as KIMBERLY HISSONG.

Based on the most recent information from CMS, provider Kimberly K Hissong is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:47 AM.

Profile Details

Provider ID
1194832006
Provider Type
Individual
Full Name
Hissong, Kimberly K
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
8/24/2006
Last Updated
9/3/2020

Contact Information

Practice Location

3315 Watt Ave, Sacramento, CA 95821-3600

(916) 481-6800

(916) 481-1881

Mailing Location

3315 Watt Ave, Sacramento, CA 95821-3600

(916) 481-6800

(916) 481-1881

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License C139617 California
Code 207L00000X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 185262-1205 Utah

Provider Identifiers

ID	Description	Issuer
ID 107005891101	Description Other	Issuer IHC Utah
ID 36403	Description Other	Issuer PEHP Utah
ID 416939	Description Other	Issuer DESERET MUTUAL Utah
ID 09300	Description Other	Issuer VALLEY CHILDRENS HEALTHCARE California
ID PR00880	Description Other	Issuer MOLINA Utah
ID 2403	Description Other	Issuer HEALTHY U Utah
ID 002084559	Description Other	Issuer FIRST HEALTH Utah
ID 870280408HI1	Description Other	Issuer EDUCATORS MUTUAL Utah
ID 2000040	Description Other	Issuer UNITED HEALTHCARE Utah
ID QM0000049524	Description Other	Issuer ALTIUS Utah
ID 002966900	Description Medicaid	Issuer Unlisted Idaho
ID 111000400	Description Medicaid	Issuer Unlisted Wyoming
ID 401765	Description Medicaid	Issuer Unlisted Montana

Kimberly K Hissong

PECOS Enrollment

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