NPIMap

Individual provider Active NPI

Kimberly Susann Wilson, APRN

  • Adult Health Nurse Practitioner
  • Spartanburg, SC
National Provider Identifier
1689812802
Registry record updated Jan 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
3974 Issued in SC
Practice address
101 E Wood St
Spartanburg, SC 29303-3040
Phone
(864) 560-6000
Fax
(864) 560-7715
NPI assigned
Jan 26, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 3974 SC Primary

Addresses

Primary practice location

101 E Wood St
Spartanburg, SC 29303-3040

Mailing address

PO Box 2168
Spartanburg, SC 29304-2168
Phone (864) 560-4123

Other identifiers 1

IdentifierTypeStateIssuer
NP1547MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwilson37292@direct-srhs.et0939.epichosted.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100331000962 SC Practitioner - Nurse Practitioner 6103952924 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

1 Saint Francis Dr
Greenville, SC 29601-3955
Phone (864) 255-1000

Hospital & facility affiliations

  • St Francis-Downtown Hospital, Greenville, SC, CCN 420023

Merit-based Incentive Payment System (MIPS)

Final score
82.4 of 100Reported as group
Quality
65.6
Improvement activities
40
Cost
71.06

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center CurrentSince Jan 11, 2010 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Vitalen Inpatient Care, PC CurrentSince Feb 15, 2023 Accepting new patients
Galen Inpatient Physicians PC CurrentSince Jul 9, 2024 Accepting new patients
Spartanburg Medical Center CurrentSince Jan 11, 2010 Accepting new patients
Spartanburg Regional Med Ctr CurrentSince Sep 7, 2014 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Pelham Medical Center CurrentSince Sep 7, 2014 Accepting new patients
Vitalen Inpatient Care PC CurrentSince Feb 15, 2023 Accepting new patients
Galen Inpatient Physicians PC CurrentSince Jul 9, 2024 Accepting new patients
Pelham Medical Center CurrentSince Sep 7, 2014 Accepting new patients

Locations

125 Commonwealth Dr
Greenville, SC 29615
Phone (864) 225-1800

1 Saint Francis Dr
Greenville, SC 29601
Phone (864) 225-1000

250 Westmoreland Rd
Greer, SC 29651
Phone (864) 530-2108

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

Organizations & group practices 11

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 6

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": "1232928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1689812802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2168",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293042168",
            "telephone_number": "864-560-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E WOOD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033040",
            "telephone_number": "864-560-6000",
            "fax_number": "864-560-7715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "SUSANN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-26",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "3974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1547",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwilson37292@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kwilson37292@direct-srhs.et0939.epichosted.com",
            "address_1": "101 E Wood St",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293033040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.