KIMBERLY D FOX, M.D.

NPI 1093809782, individual, Smithfield, NC, Pediatrics

Evidence tier

structure or single-organization volume

Hours beyond a day in 24 months, but with up to 1478 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
Records needed.
Medicaid dollars per patient on code 90460 ($134 per patient-month) sit in the top 5% of every provider billing that code.

score 56 of 100, rank 7392, $8.0M at stake

Hours billed per day

Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.

month	what was found	hours per day, lower bound	hours per day, at price	hours per day, conservative	per working day	patients	billing organizations	codes	paid
Jan 2018	More hours than a day holds at a conservative unit price	19.4	38.4	25.6	34.5	977	2	99205 99212 99213 99214 99215	$133K
Feb 2018	More hours than a day holds, even counting one unit per claim line	27.3	55.1	36.7	51.4	1237	2	99205 99212 99213 99214 99215	$172K
Mar 2018	More hours than a day holds at a conservative unit price	21.3	41.7	27.8	39.2	1024	2	99205 99212 99213 99214 99215	$142K
May 2018	More hours than a day holds at a conservative unit price	18.8	37.4	24.9	33.6	920	2	99205 99212 99213 99214 99215	$128K
Oct 2018	More hours than a day holds at a conservative unit price	22.4	42.9	28.6	38.5	1238	2	99205 99212 99213 99214 99215	$151K
Nov 2018	More hours than a day holds at a conservative unit price	23.1	44.0	29.4	40.0	1163	2	99205 99212 99213 99214 99215	$149K
Jan 2019	More hours than a day holds, even counting one unit per claim line	24.5	40.0	26.7	36.0	1192	2	99205 99212 99213 99214 99215	$164K
Feb 2019	More hours than a day holds, even counting one unit per claim line	29.5	48.9	32.6	45.6	1257	2	99205 99212 99213 99214 99215	$180K
Mar 2019	More hours than a day holds, even counting one unit per claim line	25.2	41.8	27.8	41.1	1220	2	99205 99212 99213 99214 99215	$171K
Apr 2019	More hours than a day holds at a conservative unit price	22.9	37.1	24.8	33.8	1061	2	99205 99212 99213 99214 99215	$147K
Sep 2019	More hours than a day holds at a conservative unit price	22.9	38.4	25.6	36.6	1123	2	99205 99212 99213 99214 99215	$153K
Oct 2019	More hours than a day holds at a conservative unit price	23.5	39.3	26.2	35.4	1294	2	99205 99212 99213 99214 99215	$164K
Nov 2019	More hours than a day holds at a conservative unit price	23.1	38.6	25.7	36.7	1127	2	99205 99212 99213 99214 99215	$154K
Dec 2019	More hours than a day holds at a conservative unit price	22.8	38.0	25.3	35.7	1162	2	99205 99212 99213 99214 99215	$157K
Jan 2020	More hours than a day holds, even counting one unit per claim line	32.1	50.9	34.0	45.8	1478	3	99205 99212 99213 99214 99215	$221K
Feb 2020	More hours than a day holds, even counting one unit per claim line	30.7	50.4	33.6	48.7	1385	2	99205 99212 99213 99214 99215	$203K
Mar 2020	More hours than a day holds at a conservative unit price	23.7	55.1	36.7	51.8	1189	2	99205 99212 99213 99214 99215 99441 99442 99443	$238K
Jul 2020	More hours than a day holds at a conservative unit price	15.9	36.0	24.0	32.4	788	2	99205 99212 99213 99214 99215	$157K
Sep 2020	More hours than a day holds at a conservative unit price	16.4	36.9	24.6	33.6	824	2	99205 99212 99213 99214 99215	$156K
Jul 2021	More hours than a day holds, even counting one unit per claim line	30.5	31.8	21.2	29.9	913	3	99205 99212 99213 99214 99215	$130K
Aug 2021	More hours than a day holds, even counting one unit per claim line	33.4	40.6	27.1	38.2	1068	3	99205 99212 99213 99214 99215	$163K
Sep 2021	More hours than a day holds, even counting one unit per claim line	38.3	47.7	31.8	43.4	1207	3	99205 99212 99213 99214 99215	$185K
Oct 2021	More hours than a day holds, even counting one unit per claim line	27.4	37.0	24.6	36.4	1028	3	99205 99212 99213 99214 99215	$149K
Dec 2021	More hours than a day holds, even counting one unit per claim line	27.1	34.4	23.0	30.9	1080	3	99205 99212 99213 99214 99215	$140K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	KIMBERLY D FOX, M.D.
Type	Individual, sole proprietor
Status	Active
NPI issued	October 3, 2006, last updated October 31, 2025
Practice location	1519 E BOOKER DAIRY RD, Smithfield, NC 27577-9472, 919-938-2144
Specialties	Pediatrics (208000000X, primary, license 200101445 NC)

Procedures billed

The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.

Medicaid, largest codes

code	what it is	paid	share	per patient-month	typical	rank among providers
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$4.8M	34%	$134	$60 (top 5% from $133)	95th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$1.5M	11%	$81	$44 (top 5% from $110)	89th percentile
99215	Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or morehistory of abuse	$1.3M	10%	$194	$88 (top 5% from $210)	93rd percentile
90460	Administration of first vaccine or toxoid component with counseling (18 years or younger)	$1.0M	8%	$85	$26 (top 5% from $54)	100th percentile
99051	Medicaid service code	$642K	5%	$23	$6.71 (top 5% from $30)	86th percentile
99393	Medicaid service code	$592K	4%	$104	$78 (top 5% from $121)	88th percentile
99205	New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	$561K	4%	$211	$128 (top 5% from $249)	88th percentile
99394	Medicaid service code	$458K	3%	$107	$83 (top 5% from $128)	81st percentile

In this area

167 providers in NC carry an indicator in the public record, with $177.7M at stake between them. The most common is more hours than a day holds, on 84 of them, followed by part of a provider network on 42. 22 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	DAVID SMITH Winston Salem, NC, ranked 2	$1.1M	Listed on the Medicare revocation list and the SC Medicaid exclusion list since August 30, 2021. Medicaid still paid claims in 7 later months, $1,063,751 in total. and 1 more
1	MICHAEL ADIX Shelby, NC, ranked 12	$155K	Listed on the Medicare revocation list since April 18, 2023. Medicaid still paid claims in 11 later months, $154,645 in total. and 1 more
1	CAROLINA FAMILY AND URGENT CARE Lumberton, NC, ranked 30	$6K	Listed on the Medicare revocation list since September 8, 2023. Medicaid still paid claims in 7 later months, $5,787 in total. and 1 more
1	JOSEPH MEYER Fort Bragg, NC, ranked 48	$26K	Listed on the Medicare revocation list since October 20, 2006. Medicaid still paid claims in 7 later months, $26,252 in total. and 1 more
1	LIFE TOUCH LLC Kinston, NC, ranked 68	$868K	Adjudicated (charged, pleaded guilty, sentenced) per a Department of Justice release dated June 30, 2025. Medicaid paid $868,112 in the last 12 observed months.
1	ULTIMATE SACRIFICE Winston Salem, NC, ranked 96	$365K	Adjudicated (pleaded guilty) per a Department of Justice release dated April 9, 2025. Medicaid paid $364,787 in the last 12 observed months.
1	MALIK MUHAMMAD Durham, NC, ranked 116	$2K	Listed on the Medicare revocation list since October 12, 2021. Medicaid still paid claims in 1 later month, $1,779 in total. and 1 more
1	JACKSON CONSULTING AND SERVICES LLC Charlotte, NC, ranked 127	$138K	Adjudicated (sentenced) per a Department of Justice release dated August 27, 2026. Medicaid paid $137,561 in the last 12 observed months.

All 167 in NC

Recent enforcement in NC

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJSentencedAug 27, 2026

Charlotte Woman Sentenced for Defrauding the North Carolina Medicaid Program

Jackson and her company submitted over $1.9 million in claims to NC Medicaid for urine drug testing and psychotherapy services that were never performed or already paid, using Medicaid recipients' personal information, and she spent the proceeds.

DOJPleaded guiltyJul 9, 2026

Guilford County Woman Pleads Guilty to Health Care Fraud in Connection with Million Dollar Urine Drug Testing Scheme

Singleton owned and operated Joelle's Center of Hope, which submitted approximately $1,735,865 in claims to North Carolina Medicaid for urine drug tests that were not performed, listing a nurse practitioner and a doctor as ordering providers who never ordered the tests.

DOJPleaded guiltyJun 24, 2026

Raleigh Man Pleads Guilty to Receiving More than $60 Million in Fraudulent Claims from Paying Kickbacks for Patient Referrals

Price owned and operated Golden Star Labs, which paid collectors on a per-specimen basis to supply bogus respiratory test samples obtained through identity theft, and billed Medi-Cal and Medicare more than $96 million in false claims, receiving more than $60 million, and he also filed a false federal income tax return.

DOJChargedJun 24, 2026

McLeansville Woman Charged With Health Care Fraud, Part of National Health Care Fraud Takedown

White, the owner of Reginald Center of Turn Around, billed North Carolina Medicaid for thousands of fictitious drug tests resulting in a loss of $2.8 million.

DOJIndictedJun 24, 2026

Felon Indicted in Multimillion Dollar Healthcare Kickback and False Documents Conspiracy

Ayyad is alleged to have solicited and received kickbacks from clinical laboratories in exchange for generating referrals, paid kickbacks to independent contractor sales reps, created dozens of sham invoices and contracts to conceal the payments, and caused the submission of fraudulent claims for laboratory testing to Medicare, HRSA, TRICARE, and other payers through labs and entities he owned and controlled.

Referral packet

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