Kimberly Rene Claffey, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.024017 Issued in IL

Practice address

5100 Lake Ter NE Ste WC
Mount Vernon, IL 62864-9665

Phone

(618) 899-5001

Fax

(618) 242-5152

NPI assigned

Sep 17, 2021

Last updated

Sep 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premise Health of Illinois Medical PCGroup PAC ID 3971764762, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Premise Health of Illinois Medical PC

  dba Mount Vernon Health Center Mt Vernon

  • Primary Care Clinic/Center
  • Mount Vernon, IL
  • NPI 1427366921
  Medicare reassignment Care Compare group NPD
• Physician Services Corporation of Southern Illinois Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment NPD
• Premise Health of Illinois Medical PC

  dba MCL Health Center - Utica

  • Multi-Specialty Clinic/Center
  • Utica, IL
  • NPI 1295518868
  NPD
• Premise Health of Illinois Medical, PC

  dba Walgreens Healthy Living Center Deerfield

  • Primary Care Clinic/Center
  • Deerfield, IL
  • NPI 1033494976
  NPD (past)

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1194495424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 LAKE TER NE STE WC",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649665",
            "telephone_number": "618-899-5001",
            "fax_number": "618-242-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 LAKE TER NE STE WC",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649665",
            "telephone_number": "618-899-5001",
            "fax_number": "618-242-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAFFEY",
        "first_name": "KIMBERLY",
        "middle_name": "RENE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.024017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Counseling and Family Services
• Christian Social Services of Illinois
• Christopher Greater Area Rural Health Planning Corporation (Mt. Vernon Health & Wellness Center)
• Christopher Greater Area Rural Health Planning Corporation
• Kevin B Claffey, M.D.
• Steven J Clark, MD
• Jamie Lynn Clarke, MSW
• Jill Clarke, PHARM. D.
• Koletta Rae Clarke, COTA
• Clarkson Optometry Illinois PC (Clarkson Eye Care)

• Family Nurse Practitioner in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.