Kimberly Fuller, MSN, ACNP - BS

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

R853474 Issued in MS

Practice address

2100 Highway 61 N
Vicksburg, MS 39183-8211

Phone

(601) 883-5000

NPI assigned

Aug 18, 2008

Last updated

Mar 16, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Quad Intermed Company LLCGroup PAC ID 6709245954, 42 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adoration Home Health Home health agency, Vicksburg, MS, CCN 257103
• Merit Health River Region Hospital, Vicksburg, MS, CCN 250031

Merit-based Incentive Payment System (MIPS)

Final score

89.9 of 100Reported as group

Quality

80.75

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kfuller3070451@direct.casso.us.com

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.

• Quad Intermed Company LLC

  • Clinic/Center
  • Laurel, MS
  • NPI 1952099913
  Medicare reassignment Care Compare group NPD
• App of Mississippi Ed, LLC

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1730687740
  Medicare reassignment NPD
• Mississippi Physicians LLP

  • Emergency Medicine Physician
  • Corinth, MS
  • NPI 1902174832
  Medicare reassignment NPD
• Mississippi Physicians LLP

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1982011714
  NPD
• Quad Intermed Company LLC

  • Clinic/Center
  • Yazoo City, MS
  • NPI 1093403065
  NPD
• Quad Intermed Company LLC

  dba MEA Medical Clinics

  • Clinic/Center
  • Pearl, MS
  • NPI 1205619483
  NPD

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

• Amedisys Mississippi, LLC

  dba Adoration Home Health

  • Home Health Agency
  • Vicksburg, MS
  • NPI 1245288943
  Care Compare affiliation
• Vicksburg Healthcare LLC

  dba Merit Health River Region

  • General Acute Care Hospital
  • Vicksburg, MS
  • NPI 1215981303
  Care Compare affiliation

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237161600000",
    "number": "1083860324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838211",
            "telephone_number": "601-883-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838211",
            "telephone_number": "601-883-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "MSN, ACNP - BS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2009-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R853474",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "R853474",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07281200",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1347574",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Ron Freeman, PT
• Valerie French
• Fresenius Medical Care Vicksburg Home, LLC (Fresenius Kidney Care Vicksburg Home)
• Frier Family Eye Care Inc (Acute Vision Eye Clinic)
• Jill Frier, O.D.
• Jonathan Fulton, PHARM. D.
• Joseph Gaines
• Breanna Supree Alezandri Gamble
• Hailey Garner
• Garrett Rouse Garrett Rouse

• Acute Care Nurse Practitioner in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Acute Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.