Kimberly Diane Altizer, NP-C
Individual provider Active NPI Nurse Practitioner · Brookneal, VA
NPI 1609397462 · NPPES record last updated Jul 3, 2017
Key facts
- NPI
- 1609397462
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 0024174933 (VA)
- Practice address
- 104 Carolina Ave
Brookneal, VA 24528-2643 - Phone
- (434) 376-2325
- NPI assigned
- Jul 3, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Centra Medical Group LLC
Practice addresses (Care Compare)
104 Carolina Ave
Brookneal, VA 24528-2643
Phone (434) 376-2325
Hospital & facility affiliations
- Centra Health - Lynchburg Gen Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.16 of 100
- Quality
- 83.58
- Promoting interoperability
- 94
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171227002342 | VA | Practitioner - Nurse Practitioner | 7012275878 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024174933 | VA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centra Medical Group, LLC | Current |
Accepting new patients | |
| Centra Medical Group, LLC | Past |
Accepting new patients |
Locations
104 Carolina Ave
Brookneal, VA 24528
Phone (434) 376-2325
125 Nationwide Dr
Lynchburg, VA 24502
Phone (434) 200-3908
2010 Atherholt Rd
Lynchburg, VA 24501
Phone (434) 200-3656
1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101
2125 Langhorne Rd
Ste 401
Lynchburg, VA 24501
Phone (434) 200-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 0024174933 | VA | Yes |
Addresses
Primary practice location
104 Carolina Ave
Brookneal, VA 24528-2643
Mailing address
443 Carriage Pkwy
Rustburg, VA 24588-4573
Phone (434) 907-5614
Other providers in Brookneal, VA
- Paulina Amoah
- Laura Ann Elizabeth Broggin
- Brookneal Drug Co Inc
- Brookneal Life Care Corp
- Brookneal Optical, Inc
All providers in Brookneal, VA · Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.