Kimberly Russom, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

31286 Issued in TN

Practice address

1705 W Reelfoot Ave
Union City, TN 38261-5569

Phone

(731) 599-1102

Fax

(731) 599-1107

NPI assigned

Mar 29, 2022

Last updated

Mar 29, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

May accept Medicare assignment

Group practices

Hometown Urgent Care of Dyersburg, PLLCGroup PAC ID 8820349202, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Hometown Urgent Care of Dyersburg PLLC

  • Urgent Care Clinic/Center
  • Dyersburg, TN
  • NPI 1003318593
  Medicare reassignment Care Compare group NPD
• Apex Cardiology PC

  • Interventional Cardiology Physician
  • Jackson, TN
  • NPI 1467494070
  Medicare reassignment NPD
• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Spring Hill, TN
  • NPI 1134452865
  Medicare reassignment NPD
• Apex Cardiology PC

  dba Rural Health Clinic

  • Rural Health Clinic/Center
  • Henderson, TN
  • NPI 1073906616
  NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1508506536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 W REELFOOT AVE",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615569",
            "telephone_number": "731-599-1102",
            "fax_number": "731-599-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 W REELFOOT AVE",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615569",
            "telephone_number": "731-599-1102",
            "fax_number": "731-599-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOM",
        "first_name": "KIMBERLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "31286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Brooke Rose, COTA/L
• Morgan Rudd, DPT
• Bobby James Russell, D.PH.
• Laura Russell, CFNP
• Mylinda Orene Russell, SR. PSYCH. EXAMINER
• Karyn Satterfield, MPT
• Grover Ferdinand Schleifer III, MD
• Chelsea Shannon, FNP-BC
• Philip A Sherman, M.D.
• Tyler Sherwood, PA-C

• Family Nurse Practitioner in Union City, TN
• Providers in Union City, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.