Individual provider Active NPI

Breeann Gilmore, C.R.N.P,

  • Family Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1679941884
Registry record updated Sep 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-121555 Issued in AL
Practice address
480 Honeysuckle Rd
Dothan, AL 36305-1156
Phone
(334) 836-1212
NPI assigned
Sep 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-121555 AL Primary

Addresses

Primary practice location

480 Honeysuckle Rd
Dothan, AL 36305-1156

Mailing address

480 Honeysuckle Rd
Dothan, AL 36305-1156
Phone (334) 836-1212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20151112000449 AL Practitioner - Nurse Practitioner 5496065914 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gut PCGroup PAC ID 3375589799, 53 clinicians

Practice addresses (Care Compare)

480 Honeysuckle Rd
Dothan, AL 36305-1156
Phone (334) 836-1212

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-121555ALMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gut PC CurrentSince Sep 1, 2015 Accepting new patients
Gut PC CurrentSince Sep 1, 2015 Accepting new patients

Locations

480 Honeysuckle Rd
Dothan, AL 36305
Phone (334) 792-6933

614 N Main St
Ste A
Enterprise, AL 36330
Phone (334) 489-4244

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1679941884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 HONEYSUCKLE RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051156",
            "telephone_number": "334-836-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 HONEYSUCKLE RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051156",
            "telephone_number": "334-836-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "BREEANN",
        "credential": "C.R.N.P,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-121555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.