Individual provider Active NPI

Karen McNeely, BSN NP

  • Nurse Practitioner
  • Statesboro, GA
National Provider Identifier
1104228402
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN089620 Issued in GA
Practice address
114 Hill Pond LN
Statesboro, GA 30458-0872
Phone
(912) 681-6944
NPI assigned
Sep 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN089620 GA Primary

Addresses

Primary practice location

114 Hill Pond LN
Statesboro, GA 30458-0872

Mailing address

114 Hill Pond LN
Statesboro, GA 30458-0872
Phone (912) 681-6944

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20150601002076 GA Practitioner - Nurse Practitioner 3274854351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peterson Dermatology, P.C.Group PAC ID 7113018334, 4 clinicians

Practice addresses (Care Compare)

305 W 1St St
Vidalia, GA 30474-3302
Phone (912) 538-9080

Merit-based Incentive Payment System (MIPS)

Final score
77.65 of 100Reported as group
Quality
55.3
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peterson Dermatology, P.C. CurrentSince May 23, 2016 Accepting new patients

Locations

305 W 1st St
Vidalia, GA 30474
Phone (912) 538-9080

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1104228402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-681-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-681-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNEELY",
        "first_name": "KAREN",
        "credential": "BSN NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN089620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.