KIMBERLY GILLIARD BROADWELL ACNP
NPI 1255928479
Nurse Practitioner - Acute Care in Raleigh, NC

Active since December 22, 2020PECOS EnrolledAccepts Medicare Assignment
4420 LAKE BOONE TRL, RALEIGH, NC 27607(919) 784-3542 Get Directions Write a Review

NPPES record last updated: May 3, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: May 3, 2021, Feb 2, 2021, Dec 28, 2020 and 1 more (4 updates tracked since 2020).

About Kimberly Gilliard Broadwell Acnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY GILLIARD BROADWELL ACNP (NPI 1255928479) is an individual acute care provider in Raleigh, North Carolina, licensed in North Carolina (5013905) and active in the NPI registry since December 2020. She is enrolled in Medicare PECOS, is affiliated with Rex Hospital, and maintains a secondary practice location in Raleigh.

NPPES Registry Identity

NPI1255928479
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameKIMBERLY GILLIARD BROADWELLCredential: ACNP
Location Address4420 LAKE BOONE TRLRaleigh, NC 27607-7505
Mailing Address128 White Cap LnGarner, NC 27529-3959 · (919) 624-6097
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateDecember 22, 2020
Last NPPES UpdateMay 3, 20214 updates tracked since enumeration
NPPES CertifiedMay 3, 2021
NPI 1255928479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License Licensed in NC · 5013905
4420 LAKE BOONE TRL, Raleigh, NC 27607

Other Names 1

Former Name (1)Kimberly Anne Gilliard

Secondary Practice Location 1

Location 12800 Blue Ridge RdRaleigh, NC 27607-6478 · Phone (919) 787-5380

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kimberly Gilliard Broadwell Acnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7113331067
PECOS Enrollment IDI20210204000627
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
36 services35 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Rex Hospital

Acute Care Hospitals · Raleigh, NC
5/5 CMS rating
OwnershipGovernment - State
CMS Certification Number340114
Location4420 Lake Boone TrailRaleigh, NC 27607 · Wake County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27607 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.90 typical visit price
range $54.12 – $165.09
Typical copayment $20.97 (range $13.53 – $41.27)
Most-billed visit code 99203
Established Patient
$95.94 typical visit price
range $17.21 – $134.61
Typical copayment $23.98 (range $4.30 – $33.65)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pathology (Anatomic Pathology & Clinical Pathology)
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Pathology (Anatomic Pathology & Clinical Pathology)
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Pathology (Anatomic Pathology & Clinical Pathology)
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Pathology (Anatomic Pathology & Clinical Pathology)
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Pathology (Anatomic Pathology & Clinical Pathology)
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Pathology (Anatomic Pathology & Clinical Pathology)
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Physician Assistant
4420 LAKE BOONE TRL
RALEIGH, NC 27607
Physician Assistant
4420 LAKE BOONE TRL
RALEIGH, NC 27607

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1255928479, enumerated as an "individual" on December 22, 2020.

The provider is located at 4420 LAKE BOONE TRL RALEIGH, NC 27607 and the phone number is (919) 784-3542.

Nurse Practitioner with taxonomy code 363LA2100X and a focus in Acute Care.

The provider might be accepting Accepts: Blue Cross and Blue Shield of NC. Please consult your insurance carrier or call the provider to verify.

Kimberly Broadwell is affiliated with: REX HOSPITAL.