Timothy P Kerut, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

11047 Issued in MS

Practice address

2200 Highway 61 N
Vicksburg, MS 39183-8246

Phone

(601) 883-3320

NPI assigned

Jul 5, 2006

Last updated

Sep 29, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Allergy/Immunology

Education

University of Mississippi School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vicksburg Clinic LLCGroup PAC ID 5890696330, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Merit Health River Region Hospital, Vicksburg, MS, CCN 250031

Merit-based Incentive Payment System (MIPS)

Final score

88.07 of 100Reported as apm

Quality

73.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.kerut.1@1475.direct.athenahealth.com

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.

• Vicksburg Clinic LLC

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1790711158
  Medicare reassignment Care Compare group NPD
• Vicksburg Allergy and Asthma

  • Allergy & Immunology Physician
  • Vicksburg, MS
  • NPI 1619140399
  NPD (past) Authorized official
• Vicksburg Clinic LLC

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1659307791
  NPD (past)

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

• Vicksburg Healthcare LLC

  dba Merit Health River Region

  • General Acute Care Hospital
  • Vicksburg, MS
  • NPI 1215981303
  Care Compare affiliation

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1932130127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MCAULEY DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832825",
            "telephone_number": "601-638-7271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838246",
            "telephone_number": "601-883-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERUT",
        "first_name": "TIMOTHY",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2026-09-29",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MS",
            "license": "11047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120441",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5694020",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1546143",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "timothy.kerut.1@1475.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "2200 Highway 61 N",
            "city": "Vicksburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391838246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kevin Keith Keen, D.M.D.
• Keeping Focus LLC.
• Logan Kelley, PHARM. D
• Madelyn Grace Kelly
• Rhonda Kemp, FNP
• Kidzplay Community
• Freda Jemutai Kigen, PMHNP-BC
• Deborah Davis Kilgo, CCC-SLP
• Michael Edward Killen, CRNA
• Kimberly Renee Kilpatrick, CFNP

• Allergy & Immunology Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Allergy & Immunology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.

Verify at the official NPI Registry.