Individual provider Active NPI

Kimberly Ann Mella, NP

  • Nurse Practitioner
  • Plant City, FL
National Provider Identifier
1467420455
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP2742832 Issued in FL
Practice address
301 N Alexander St
Plant City, FL 33563-4303
Phone
(813) 757-1290
NPI assigned
Mar 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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 ARNP2742832 FL Primary

Addresses

Primary practice location

301 N Alexander St
Plant City, FL 33563-4303

Mailing address

14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865

Other identifiers 1

IdentifierTypeStateIssuer
303931500MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20031210000216 FL Practitioner - Nurse Practitioner 2668378787 Reassigns benefits to 1 organization
I20160823001691 CA Practitioner - Nurse Practitioner 2668378787 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

275 Hospital Pkwy
San Jose, CA 95119-1106
Phone (408) 972-3000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 27, 2019 Accepting new patients
Mid-Florida Emergency Physicians, LLC Nurse Practitioner CurrentSince Oct 1, 2016 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 27, 2019 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Town & Country Emergency Physicians LLC Past Accepting new patients
Sarasota Emergency Associates PA Past Accepting new patients
Northport Emergency Associates, PA Past Accepting new patients
Baxley Emergency Physicians LLC Past Accepting new patients
Florida Em-I Medical Services PA Past Accepting new patients
Palms of Pasadena Emergency Physicians LLC Past Accepting new patients
Emergency Physician Specialists Inc Past Accepting new patients
Osprey Emergency Physicians LLC Past Accepting new patients
Ambulatory Care Physicians of Sarasota LLC Past Accepting new patients
The Healthcaring Clinic of Florida, LLC Past Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

3600 S Highlands Ave
Sebring, FL 33870
Phone (863) 385-6101

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1467420455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 NW 14TH ST",
            "address_2": "SUITE 190",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N ALEXANDER ST",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335634303",
            "telephone_number": "813-757-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLA",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP2742832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "303931500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plant City, FL

Sources for this page

Verify at the official NPI Registry.