Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Koby Kimball, PA-C

Individual provider Physician Assistant · NPI 1184338550

Koby Kimball, PA-C is a Physician Assistant in Springfield, Illinois. Qualified in 2025, 1 year ago. Practices with Prairie Cardiovascular Consultants Ltd, a 94-clinician group and accepts Medicare assignment.

Years since qualifying
1
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

619 E Mason St
Springfield, IL 62701-1034
Phone: (217) 788-0706
Fax: (217) 525-2535
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1184338550
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJanuary 10, 2023
Last updated in NPPESSeptember 16, 2025
Certification dateSeptember 16, 2025
Mailing address619 E Mason St, Springfield, IL 62701-1034

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Prairie Cardiovascular Consultants Ltd — 94 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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