NPIMap

Individual provider Active NPI

Lyn-Marie Kuball, FNP

  • Family Nurse Practitioner
  • Little River, SC
National Provider Identifier
1922632702
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
105268 Issued in SC
Practice address
4303 Live Oak Dr
Little River, SC 29566-9138
Phone
(843) 663-8000
Fax
(843) 663-8123
NPI assigned
Mar 2, 2020
Last updated
Mar 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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 105268 SC Primary

Addresses

Primary practice location

4303 Live Oak Dr
Little River, SC 29566-9138

Mailing address

PO Box 547
Little River, SC 29566-0547
Phone (843) 663-8000

Other identifiers 1

IdentifierTypeStateIssuer
0OtherSC0

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lkuball@LRMC.eclinicaldirectplus.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
I20200330002033 SC Practitioner - Nurse Practitioner 0042649824 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Little River Medical Center IncGroup PAC ID 2961309315, shared by 7 NPIs, 38 clinicians

Practice addresses (Care Compare)

1075 Mr Joe White Ave
Unit 101
Myrtle Beach, SC 29577-5658
Phone 84366380008294

3515 Caduceus Dr
Suite B
Myrtle Beach, SC 29588-2922
Phone (843) 663-8013

3817 Main St
Loris, SC 29569-3017
Phone (843) 663-8000

4220 Carolina Exchange Dr
Myrtle Beach, SC 29579-4220
Phone 84366380008294

4303 Live Oak Dr
Little River, SC 29566-9138
Phone (843) 663-8000

7724 N Kings Hwy
Myrtle Beach, SC 29572-3041
Phone (843) 663-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105268SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Little River Medical Center, Inc. Family CurrentSince Mar 2, 2020 Accepting new patients
Little River Medical Center, Inc CurrentSince Mar 2, 2020 Accepting new patients
Little River Medical Center, Inc. CurrentSince Mar 2, 2020 Accepting new patients
Little River Medical Center, Inc. Family CurrentSince Mar 2, 2020 Accepting new patients
Little River Medical Center Inc Family CurrentSince Mar 2, 2020 Accepting new patients

Locations

4303 Live Oak Dr
Little River, SC 29566
Phone (803) 839-3939

3817 Main St
Loris, SC 29569
Phone (843) 806-2601

3515 Caduceus Dr
Ste B
Myrtle Beach, SC 29588
Phone (843) 651-5689

4220 Carolina Exchange Dr
Myrtle Beach, SC 29579
Phone (843) 663-8013

7724 N Kings Hwy
Myrtle Beach, SC 29572
Phone (843) 839-3939

Interoperability endpoints

  • Direct secure messaging: lkuball@lrmc.eclinicaldirectplus.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1922632702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295660547",
            "telephone_number": "843-663-8000",
            "fax_number": "843-663-8123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 LIVE OAK DR",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295669138",
            "telephone_number": "843-663-8000",
            "fax_number": "843-663-8123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBALL",
        "first_name": "LYN-MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-02",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "105268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkuball@LRMC.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4303 Live Oak Dr",
            "city": "Little River",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295669138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Little River, SC

Sources for this page

Verify at the official NPI Registry.