NPIMap

Individual provider Active NPI

Kimalisa Locklear

  • Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1306482500
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5012570 Issued in NC
Practice address
3637 Cape Center Dr
Fayetteville, NC 28304-4457
Phone
(910) 491-1760
Fax
(910) 491-1764
NPI assigned
Nov 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

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 5012570 NC Primary

Addresses

Primary practice location

3637 Cape Center Dr
Fayetteville, NC 28304-4457

Mailing address

3637 Cape Center Dr
Fayetteville, NC 28304-4457
Phone (910) 491-1760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200113002691 NC Practitioner - Nurse Practitioner 5496180820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Cape Fear Medical Group, PAGroup PAC ID 2466689641, 5 clinicians

Practice addresses (Care Compare)

3637 Cape Ctr Dr
Fayetteville, NC 28304-4457
Phone (910) 491-1760

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

Merit-based Incentive Payment System (MIPS)

Final score
90.95 of 100Reported as group
Quality
89.73
Improvement activities
40
Cost
79.19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5012570NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Cape Fear Medical Group, PA CurrentSince Dec 1, 2019 Accepting new patients
Harris Family Practice PLLC Past Accepting new patients
Healthsouth Men'S Clinic PastSince Nov 24, 2019 Accepting new patients

Locations

3637 Cape Center Dr
Fayetteville, NC 28304
Phone (910) 483-4938

Organizations & group practices 3

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1306482500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 CAPE CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044457",
            "telephone_number": "910-491-1760",
            "fax_number": "910-491-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3637 CAPE CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044457",
            "telephone_number": "910-491-1760",
            "fax_number": "910-491-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKLEAR",
        "first_name": "KIMALISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-22",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.