Mary Kathryn Reep Zicarelli

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-036663 Issued in AL

Practice address

34011 US Highway 280
Childersburg, AL 35044-2128

Phone

(256) 378-3313

Fax

(256) 378-3315

NPI assigned

Sep 16, 2009

Last updated

Jan 3, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Metro Infectious Disease Consultants, LLC

  dba Midc, LLC

  • Infectious Disease Physician
  • Burr Ridge, IL
  • NPI 1235125717

  AL

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AL

  Medicare reassignment NPD
• Metro Infectious Disease Consultants LLC

  dba Midc

  • Infectious Disease Physician
  • Jonesboro, GA
  • NPI 1770307191
  NPD
• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Plymouth, MI
  • NPI 1841530250
  NPD (past)

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1356674741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 349",
            "address_2": "34011 HWY 280 EAST",
            "city": "CHILDERSBURG",
            "state": "AL",
            "postal_code": "350440349",
            "telephone_number": "256-378-3313",
            "fax_number": "256-378-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34011 US HIGHWAY 280",
            "city": "CHILDERSBURG",
            "state": "AL",
            "postal_code": "350442128",
            "telephone_number": "256-378-3313",
            "fax_number": "256-378-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZICARELLI",
        "first_name": "MARY KATHRYN",
        "middle_name": "REEP",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-16",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-036663",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-036663",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1021507842",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125065",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Stamps, LPTA
• The Sylacauga Health Care Authority (Nix Family Medicine)
• Troy H. Dennis D.M.D. PC
• Terry R Walters
• Clarissa Wheeler, HAIR LOSS SPECIALIST

• Family Nurse Practitioner in Childersburg, AL
• Providers in Childersburg, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.