Active NPI
Kimberly Soutuyo, NP
- Acute Care Nurse Practitioner
- Fairfax, VA
National Provider Identifier
1871998302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 0024172024
- Practice address
- 2722 Merrilee Dr
Suite 230
Fairfax, VA 22031-4420 - Phone
- (703) 698-4444
- Fax
- (703) 204-0116
- NPI assigned
- Oct 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 0024172024 | VA | Primary |
Addresses
Primary practice location
2722 Merrilee Dr
Suite 230
Fairfax, VA 22031-4420
Mailing address
2722 Merrilee Dr
Suite 230
Fairfax, VA 22031-4420
Phone (703) 698-4444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141223001882 | DC | Practitioner - Nurse Practitioner | 5294058277 | Reassigns benefits to 1 organization |
| I20250703001762 | SC | Practitioner - Nurse Practitioner | 5294058277 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Careteam Plus Inc
Practice addresses (Care Compare)
100 Professional Park Dr
Conway, SC 29526-9260
Phone (843) 234-0005
Hospital & facility affiliations
- Amedisys Home Health of Conway
- Conway Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.13 of 100
- Quality
- 90.26
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024172024 | VA | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capital Healthcare PC | Current | Accepting new patients | |
| Careteam Plus, Inc. | Current | Accepting new patients | |
| Careteam Plus, Inc. | Current | Accepting new patients | |
| Careteam Plus, Inc. | Past | Accepting new patients |
Locations
100 Professional Park Dr
Conway, SC 29526
Phone (843) 234-0005
6020 Richmond Hwy
Ste 102
Alexandria, VA 22303
Phone (267) 978-1993
Interoperability endpoints
- kimberley.soutuyo.1@19266.direct.athenahealth.com
- kimberly.soutuyo.1@14940.direct.athenahealth.com
Organizations & group practices 5
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.
-
- Federally Qualified Health Center (FQHC)
- Conway, SC
- NPI 1427363209
-
- Specialty Pharmacy
- Conway, SC
- NPI 1033738133
-
- Federally Qualified Health Center (FQHC)
- Conway, SC
- NPI 1194541383
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Conway, SC
- NPI 1316905573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414368000000",
"number": "1871998302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2722 MERRILEE DR",
"address_2": "SUITE 230",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220314420",
"telephone_number": "703-698-4444",
"fax_number": "703-204-0116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2722 MERRILEE DR",
"address_2": "SUITE 230",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220314420",
"telephone_number": "703-698-4444",
"fax_number": "703-204-0116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTUYO",
"first_name": "KIMBERLY",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-27",
"last_updated": "2014-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "VA",
"license": "0024172024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.