Individual provider Active NPI

Marissa F Kleffman Underwood, ARNP

  • Family Nurse Practitioner
  • Greenville, NC
National Provider Identifier
1144691528
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
264412 Issued in NC
Practice address
1204 E Fire Tower Rd
Greenville, NC 27858-4196
Phone
(252) 744-1122
Fax
(252) 744-1133
NPI assigned
Oct 12, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5008128 NC
Family Nurse Practitioner 363LF0000X 264412 NC Primary
Nurse Practitioner 363L00000X ARNP9467370 FL

Addresses

Primary practice location

1204 E Fire Tower Rd
Greenville, NC 27858-4196

Mailing address

PO Box 751069
Charlotte, NC 28275-1069

Other practice location 1

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Other practice location 2

381 Ruin Creek Rd
Henderson, NC 27536-2932
Phone (252) 430-0666 ext. 417

Other identifiers 3

IdentifierTypeStateIssuer
19GSYOtherBCBS OF NC
1144691528MedicaidNC
NCR001BOtherNCMEDICARE

Other names 1

  • Marissa F Kleffman Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkleffmanunderwood283066@direct.ecuhealth.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20160127001640 NC Practitioner - Nurse Practitioner 7911200811 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
East Carolina UniversityGroup PAC ID 0244143246, 499 clinicians

Practice addresses (Care Compare)

1204 E Fire Tower Rd
Greenville, NC 27858-4196
Phone (252) 744-1122

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP9467370FLMDNurse Practitioner
5008128NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina University CurrentSince Oct 1, 2018 Accepting new patients
Vance Family Medicine, PA CurrentSince Nov 19, 2015 Accepting new patients
East Carolina University CurrentSince Oct 1, 2018 Accepting new patients
East Carolina University Past Accepting new patients

Locations

600 Moye Blvd
Greenville, NC 27834
Phone (252) 744-1111

1204 E Fire Tower Rd
Greenville, NC 27858
Phone (252) 744-1122

381 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 430-0666

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 3

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": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1144691528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 E FIRE TOWER RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278584196",
            "telephone_number": "252-744-1122",
            "fax_number": "252-744-1133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 San Pablo Rd S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322241865",
            "country_code": "US",
            "telephone_number": "904-953-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "381 Ruin Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NC",
            "postal_code": "275362932",
            "country_code": "US",
            "telephone_number": "252-430-0666 x417",
            "fax_number": "252-430-7503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLEFFMAN UNDERWOOD",
        "first_name": "MARISSA",
        "middle_name": "F",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5008128",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "264412",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9467370",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "19GSY",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144691528",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NCR001B",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkleffmanunderwood283066@direct.ecuhealth.com",
            "affiliation": "N",
            "endpointDescription": "ECU Physicians",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1204 E Fire Tower Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278584196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "KLEFFMAN",
            "middle_name": "F",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.