Individual provider Active NPI

Kelly Hinson, ACNP

  • Acute Care Nurse Practitioner
  • Sullivan, MO
National Provider Identifier
1558729905
Registry record updated Jan 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2016002422 Issued in MO
Practice address
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone
(573) 468-4186
NPI assigned
Jan 31, 2016
Last updated
Jan 31, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2016002422 MO Primary

Addresses

Primary practice location

751 Sappington Bridge Rd
Sullivan, MO 63080-2354

Mailing address

1720 Franklin Dr
Saint Clair, MO 63077-1025
Phone (636) 633-6066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20161104000667 MO Practitioner - Nurse Practitioner 5294773909 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Adult Hospitalists - Washington, LLCGroup PAC ID 3577630540, 31 clinicians

Practice addresses (Care Compare)

901 E 5TH St
Washington, MO 63090-3127
Phone (636) 239-8231

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Adult Critical Care, LLC CurrentSince Oct 1, 2021 Accepting new patients
Mercy Clinic Adult Hospitalists - Washington, LLC CurrentSince Sep 13, 2017 Accepting new patients

Locations

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1454198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454198400000",
    "number": "1558729905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 FRANKLIN DR",
            "city": "SAINT CLAIR",
            "state": "MO",
            "postal_code": "630771025",
            "telephone_number": "636-633-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 SAPPINGTON BRIDGE RD",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802354",
            "telephone_number": "573-468-4186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINSON",
        "first_name": "KELLY",
        "name_prefix": "Mr.",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-31",
        "last_updated": "2016-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2016002422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.