NPIMap

Individual provider Active NPI

Laura Russell, CFNP

  • Family Nurse Practitioner
  • Union City, TN
National Provider Identifier
1710974761
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN11001 Issued in TN
Practice address
1109 E Reelfoot Ave
Suite C
Union City, TN 38261-5856
Phone
(731) 884-0600
Fax
(731) 885-6171
NPI assigned
Oct 4, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 APN11001 TN Primary

Addresses

Primary practice location

1109 E Reelfoot Ave
Suite C
Union City, TN 38261-5856

Mailing address

1109 E Reelfoot Ave
Suite C
Union City, TN 38261-5856
Phone (731) 884-0600

Other identifiers 4

IdentifierTypeStateIssuer
166248OtherTNBETTER HEALTH PLANS
34427OtherTNTLC
3723214MedicaidTN
4103819OtherTNBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20050425001093 TN Practitioner - Nurse Practitioner 8022057538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kofi Nuako MD PCGroup PAC ID 0446143374, 4 clinicians

Practice addresses (Care Compare)

1109 E Reelfoot Ave
Union City, TN 38261-5866

1109 E Reelfoot Ave C
Union City, TN 38261-5866
Phone (731) 884-0600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.76 of 100Reported as group
Quality
92.41
Improvement activities
40
Cost
72.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APN11001TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kofi Nuako, MD, PC CurrentSince Mar 1, 2005 Accepting new patients
Kentenn Anesthesia Past Accepting new patients

Locations

1109 E Reelfoot Ave
Ste B
Union City, TN 38261
Phone (731) 884-0600

1109 E Reelfoot Ave
Union City, TN 38261
Phone (336) 821-4183

1109 E Reelfoot Ave
Ste C
Union City, TN 38261
Phone (731) 884-0600

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.

Hospital & facility affiliations 5

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": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710974761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 E REELFOOT AVE",
            "address_2": "SUITE C",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615856",
            "telephone_number": "731-884-0600",
            "fax_number": "731-885-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 E REELFOOT AVE",
            "address_2": "SUITE C",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615856",
            "telephone_number": "731-884-0600",
            "fax_number": "731-885-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "LAURA",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN11001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BETTER HEALTH PLANS",
            "identifier": "166248",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TLC",
            "identifier": "34427",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3723214",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4103819",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Union City, TN

Sources for this page

Verify at the official NPI Registry.