NPIMap

Individual provider Active NPI

Gerri A Kukucka, NP

  • Family Nurse Practitioner
  • Lexington, SC
National Provider Identifier
1740888262
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
24208 Issued in SC
Practice address
5224 Sunset Blvd
Lexington, SC 29072-9259
Phone
(803) 796-4251
Fax
(803) 796-4449
NPI assigned
Oct 16, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 24208 SC
Family Nurse Practitioner 363LF0000X 24208 SC Primary

Addresses

Primary practice location

5224 Sunset Blvd
Lexington, SC 29072-9259

Mailing address

PO Box 749306
Atlanta, GA 30374-9306
Phone (803) 796-4251

Other practice location 1

18 Ash Ct
Irmo, SC 29063-9584
Phone (803) 749-9531

Other practice location 2

2435 Forest Dr
Columbia, SC 29204-2026
Phone (803) 256-5300

Other identifiers 1

IdentifierTypeStateIssuer
NP8155MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu 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
I20210106000318 SC Practitioner - Nurse Practitioner 1951714260 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

40 Pinnacle Pkwy
Elgin, SC 29045-8390
Phone (803) 424-8020

Hospital & facility affiliations

  • Kershawhealth Hospital, Camden, SC, CCN 420048
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Musc Health Columbia Medical Center Downtown Hospital, Columbia, SC, CCN 420026

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Urgent Cares LLC CurrentSince Nov 1, 2024 Accepting new patients
App of South Carolina Ed PLLC CurrentSince Mar 17, 2022 Accepting new patients
Musc Community Physicians CurrentSince Dec 9, 2021 Accepting new patients
Musc Community Physicians CurrentSince Dec 9, 2021 Accepting new patients

Locations

6167 Braided Mane Pass SW
Aiken, SC 29803
Phone (803) 502-1484

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1315 Roberts St
Camden, SC 29020
Phone (803) 432-4311

2435 Forest Dr
Columbia, SC 29204
Phone (770) 874-6859

100 Jimmy Love Ln
Columbia, SC 29212
Phone (803) 731-4055

40 Pinnacle Pkwy
Elgin, SC 29045
Phone (803) 424-5160

1304 W Bobo Newsom Hwy
Hartsville, SC 29550
Phone (469) 340-1366

5224 Sunset Blvd
Lexington, SC 29072
Phone (803) 796-4251

Interoperability endpoints

  • Direct secure messaging: gkukucka384229@direct.musc.edu
  • Direct secure messaging: gerri.kukucka.1@14940.direct.athenahealth.com

Organizations & group practices 4

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 12

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": "1602806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1740888262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749306",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749306",
            "telephone_number": "803-796-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5224 SUNSET BLVD",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290729259",
            "telephone_number": "803-796-4251",
            "fax_number": "803-796-4449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 Ash Ct",
            "address_purpose": "LOCATION",
            "city": "Irmo",
            "state": "SC",
            "postal_code": "290639584",
            "country_code": "US",
            "telephone_number": "803-749-9531",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2435 Forest Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292042026",
            "country_code": "US",
            "telephone_number": "803-256-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUKUCKA",
        "first_name": "GERRI",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-16",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "24208",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "24208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP8155",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2435 Forest Dr",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292042026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lexington, SC

Sources for this page

Verify at the official NPI Registry.