Individual provider Active NPI

Mary C Sutton, APRN

  • Family Nurse Practitioner
  • Radcliff, KY
National Provider Identifier
1194319004
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3015797 Issued in KY
Practice address
650 W Lincoln Trail Blvd Ste B
Radcliff, KY 40160-2681
Phone
(270) 532-4901
Fax
(270) 352-4900
NPI assigned
Feb 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 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 3015797 KY Primary

Addresses

Primary practice location

650 W Lincoln Trail Blvd Ste B
Radcliff, KY 40160-2681

Mailing address

650 W Lincoln Trail Blvd
Radcliff, KY 40160-2681
Phone (270) 352-4601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20220722000005 KY Practitioner - Nurse Practitioner 0648651638 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radcliff Urgent Care Clinic LLCGroup PAC ID 2264812510, 5 clinicians

Practice addresses (Care Compare)

650 W Lincoln Trail Blvd
Radcliff, KY 40160-2679
Phone (270) 352-4601

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3015797KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Radcliff Urgent Care Clinic LLC Physician Assistant CurrentSince Jun 1, 2022 Accepting new patients

Locations

650 W Lincoln Trail Blvd
Radcliff, KY 40160
Phone (270) 351-3192

650 W Lincoln Trail Blvd
Ste B
Radcliff, KY 40160
Phone (270) 352-4601

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25653/brand/1/csg/1/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": "1613952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1194319004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W LINCOLN TRAIL BLVD",
            "city": "RADCLIFF",
            "state": "KY",
            "postal_code": "401602681",
            "telephone_number": "270-352-4601",
            "fax_number": "270-352-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W LINCOLN TRAIL BLVD STE B",
            "city": "RADCLIFF",
            "state": "KY",
            "postal_code": "401602681",
            "telephone_number": "270-532-4901",
            "fax_number": "270-352-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-22",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3015797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Radcliff, KY

Sources for this page

Verify at the official NPI Registry.