Individual provider Active NPI

Kimberly R Hagen, ARNP

  • Nurse Practitioner
  • Tallahassee, FL
National Provider Identifier
1528145356
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN9185998 Issued in FL
Practice address
3334 Capital Medical Blvd #400
Tallahassee, FL 32308
Phone
(850) 877-8174
Fax
(850) 877-5636
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 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 APRN9185998 FL Primary

Addresses

Primary practice location

3334 Capital Medical Blvd #400
Tallahassee, FL 32308

Mailing address

3334 Capital Medical Blvd #400
Tallahassee, FL 32308
Phone (850) 877-8174

Other identifiers 1

IdentifierTypeStateIssuer
000690200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20070130000590 FL Practitioner - Nurse Practitioner 3476554601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2605 Welaunee Blvd
Tallahassee, FL 32308-4697
Phone (850) 877-8174

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.5 of 100Reported as group
Quality
47.27
Promoting interoperability
99
Improvement activities
40
Cost
75.24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
APRN9185998FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Orthopedic Clinic III PL CurrentSince Oct 23, 2013 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Oct 23, 2013 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Southern Medical Group, PA Past Accepting new patients

Locations

3051 6th St
Marianna, FL 32446
Phone (850) 482-0017

1401 Centerville Rd
Ste 300
Tallahassee, FL 32308
Phone (850) 877-5115

2605 Welaunee Blvd
Tallahassee, FL 32308
Phone (850) 219-1932

3334 Capital Medical Blvd
Ste 400
Tallahassee, FL 32308

3334 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 210-1808

Interoperability endpoints

  • Direct secure messaging: khagen21422@tallahasseememorial.direct-ci.com
  • Direct secure messaging: kimberly.hagen.1@18802.direct.athenahealth.com

Organizations & group practices 4

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1528145356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 CAPITAL MEDICAL BLVD #400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-877-8174",
            "fax_number": "850-877-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3334 CAPITAL MEDICAL BLVD #400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-877-8174",
            "fax_number": "850-877-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "KIMBERLY",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9185998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000690200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.