KIMBERLY RUSSOM NP
NPI 1508506536
Nurse Practitioner - Family in Union City, TN

Q: What is Kimberly Russom's NPI number?

The NPI number for Kimberly Russom is 1508506536. It was assigned to this individual provider in the NPPES registry on March 29, 2022.

Q: What is Kimberly Russom's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kimberly Russom was last updated on March 29, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 29, 2022PECOS Enrolled

1705 W REELFOOT AVE, UNION CITY, TN 38261(731) 599-1102(731) 599-1107 Get Directions Write a Review

NPPES record last updated: March 29, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Kimberly Russom Np NPPES

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

KIMBERLY RUSSOM NP (NPI 1508506536) is an individual family provider in Union City, Tennessee, licensed in Tennessee (31286) and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS, is affiliated with Dyersburg Regional Medical Center, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1508506536

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKIMBERLY RUSSOMCredential: NP

Location Address1705 W REELFOOT AVEUnion City, TN 38261-5569

Mailing Address1705 W Reelfoot AveUnion City, TN 38261-5569 · (731) 599-1102 · Fax (731) 599-1107

Phone(731) 599-1102

Fax(731) 599-1107

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateMarch 29, 2022

NPPES CertifiedMarch 29, 2022

✔ NPI 1508506536 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in TN · 31286

1705 W REELFOOT AVE, Union City, TN 38261

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, Cigna Healthcare, Oscar Insurance Company and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kimberly Russom Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6406242148

PECOS Enrollment IDI20220406001999

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.

Medicare Billing Reassignments

Medicare enrollment records show Kimberly Russom reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Hometown Urgent Care Of Dyersburg PLLC

29 mi

Urgent Care

2550 PARR AVE
Dyersburg, TN 38024

Reassigned Medicare billing, Tennessee enrollment
21 clinicians in this Medicare group

NPI 1003318593 (731) 325-5678

Apex Cardiology PC

55 mi

Interventional Cardiology

327 SUMMAR DR
Jackson, TN 38301

Reassigned Medicare billing, Tennessee enrollment
14 clinicians in this Medicare group

NPI 1467494070 (731) 423-8200

Fast Pace Medical Clinic PLLC

131 mi

Family Medicine

3813 OLD PORT ROYAL RD N
Spring Hill, TN 37174

Reassigned Medicare billing, Tennessee enrollment
985 clinicians in this Medicare group

NPI 1134452865 (931) 487-1006

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

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

Detection test by immunoassay with direct visual observation for influenza virus 87804

This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.

65 services32 patients

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) 87811

This is a test to detect COVID-19, the virus causing severe respiratory illness. It uses a method called immunoassay, which identifies the virus by its unique proteins. The test is directly observed for accuracy. It helps determine if you're currently infected.

44 services41 patients

Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) 87880

A detection test by immunoassay for Group A Strep is a quick procedure to identify a bacterial infection in your throat. It involves taking a throat swab and applying it to a test strip, which changes color if Strep bacteria are present.

33 services32 patients

Automated urinalysis test 81003

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

22 services21 patients

Detection test by immunoassay with direct visual observation for respiratory syncytial virus 87807

This is a test to identify the respiratory syncytial virus, a common cause of lung and respiratory tract infections. It uses immunoassay, a method that detects the virus through a reaction between the virus and specific antibodies. The result is visually observed.

13 services12 patients

Hospital Affiliations CMS Care Compare

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

Dyersburg Regional Medical Center

Acute Care Hospitals · Dyersburg, TN

3/5 CMS rating

OwnershipProprietary

CMS Certification Number440072

Location400 East Tickle StreetDyersburg, TN 38024 · Dyer County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 38261 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

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$93.60 typical visit price

range $16.72 – $131.41

Typical copayment $23.40 (range $4.18 – $32.85)

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 8

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

JAMIE CAMILLA PURSELL FNP

Nurse Practitioner (Family)