NPIMap

Individual provider Active NPI

Kerri Shepheard Rundstrom, NP

  • Family Nurse Practitioner
  • Brookneal, VA
National Provider Identifier
1073260824
Registry record updated Mar 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024183390 Issued in VA
Practice address
104 Carolina Ave
Brookneal, VA 24528-2643
Phone
(434) 376-2325
NPI assigned
Mar 2, 2022
Last updated
Mar 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024183390 VA Primary

Addresses

Primary practice location

104 Carolina Ave
Brookneal, VA 24528-2643

Mailing address

140 Green Shutters LN
Charlotte Court House, VA 23923-3309
Phone (434) 315-4282

Other names 1

  • Kerri Lynn Shepheard Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220517001484 VA Practitioner - Nurse Practitioner 2365829157 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians
Pai Participant 1 LLCGroup PAC ID 8123351954, 174 clinicians
Universal Health CorporationGroup PAC ID 5597912626, 120 clinicians

Practice addresses (Care Compare)

104 Carolina Ave
Brookneal, VA 24528-2643
Phone (434) 376-2325

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 947-3033

1945 Roanoke Blvd
Salem, VA 24153-6408
Phone (540) 345-3894

312 King St
Keysville, VA 23947-3659
Phone (434) 736-0292

5539 Hwy Forty Seven
Chase City, VA 23924-3727
Phone (540) 814-5344

915 S Main St
Farmville, VA 23901-2211
Phone (434) 414-3978

935 S Main St
Farmville, VA 23901-2211
Phone (434) 315-5340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Medical Group, LLC CurrentSince Jul 1, 2022 Accepting new patients
Klinic Medical PLLC CurrentSince Dec 15, 2023 Accepting new patients

Locations

104 Carolina Ave
Brookneal, VA 24528
Phone (434) 376-2325

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

780 Lynnhaven Pkwy
Ste 400
Virginia Beach, VA 23452
Phone (201) 581-3411

1201 2nd Ave
Ste 900
Seattle, WA 98101
Phone (206) 801-1621

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647043200000",
    "number": "1073260824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 GREEN SHUTTERS LN",
            "city": "CHARLOTTE COURT HOUSE",
            "state": "VA",
            "postal_code": "239233309",
            "telephone_number": "434-315-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CAROLINA AVE",
            "city": "BROOKNEAL",
            "state": "VA",
            "postal_code": "245282643",
            "telephone_number": "434-376-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNDSTROM",
        "first_name": "KERRI",
        "middle_name": "SHEPHEARD",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024183390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERRI",
            "last_name": "SHEPHEARD",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brookneal, VA

Sources for this page

Verify at the official NPI Registry.