Kimberly J Self, CRNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1-139240 Issued in AL

Practice address

20 S Main St
Arab, AL 35016-1394

Phone

(256) 586-2324

Fax

(256) 586-2321

NPI assigned

Oct 2, 2017

Last updated

Oct 2, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Family Care Arab LLCGroup PAC ID 1658671839, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshall Medical Centers Hospital, Boaz, AL, CCN 010005

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.self.premierfamilycarearab@pfca.direct.systemedx.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.

• Premier Family Care Arab LLC

  • Family Medicine Physician
  • Arab, AL
  • NPI 1245614049
  Medicare reassignment Care Compare group NPD
• Premier Family Care, LLC

  • Rural Health Clinic/Center
  • Guntersville, AL
  • NPI 1487968525
  NPD (past)

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

• HH Health System - Marshall LLC

  dba Marshall Medical Center

  • General Acute Care Hospital
  • Boaz, AL
  • NPI 1407313760
  Care Compare affiliation

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

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506902400000",
    "number": "1932619236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 S MAIN ST",
            "city": "ARAB",
            "state": "AL",
            "postal_code": "350161394",
            "telephone_number": "256-586-2324",
            "fax_number": "256-586-2321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S MAIN ST",
            "city": "ARAB",
            "state": "AL",
            "postal_code": "350161394",
            "telephone_number": "256-586-2324",
            "fax_number": "256-586-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-02",
        "last_updated": "2017-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "1-139240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brea Rich, PHARMD
• Laura Richey, OTR/L
• Robert W Hargraves MD PC
• Rural Urgent Care LLC (MainStreet Family Care)
• Rural Urgent Care LLC
• Miriam Clare Shultz, D.C.
• John David Simpson, RPH
• Nicole Sisson, LPC
• Mary Deeanna Sivley, LPN
• Jayda Shafer Smith

• Family Medicine Physician in Arab, AL
• Providers in Arab, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; 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.