Kelly Russell Burris, NP is a medicare enrolled "Nurse Practitioner - Family" in Fries, Virginia. Her current practice location is
109 Carroll Drive, Fries, Virginia. You can reach out to her office (for appointments etc.) via phone at
(888) 908-4788.
Kelly Russell Burris is licensed to practice in Virginia (license number 0021469439) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1194011007.
Provider's Profile
| Full Name | Kelly Russell Burris |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 109 Carroll Drive, Fries, Virginia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1194011007
- Provider Enumeration Date: 06/20/2011
- Last Update Date: 03/13/2024
Medicare PECOS Information:
- PECOS PAC ID: 8426227729
- Enrollment ID: I20110802000695
Medical Identifiers
Medical identifiers for Kelly Russell Burris such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194011007 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | 5007750 (North Carolina) | Secondary |
| 363L00000X | Nurse Practitioner | 0024169439 (Virginia) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 5007750 (North Carolina) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 0021469439 (Virginia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Russell Burris allows following entities to bill medicare on her behalf.
| Entity Name | Tri Area Community Health |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1346227584
PECOS PAC ID: 6204748296
Enrollment ID: O20040122000969 |
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| Entity Name | Emergency Physicians Of Southern Virginia Llp |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1417187667
PECOS PAC ID: 0345236568
Enrollment ID: O20040422001520 |
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| Entity Name | Emergency Coverage Services Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1053351593
PECOS PAC ID: 8820983430
Enrollment ID: O20061003000679 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Russell Burris is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kelly Russell Burris, NP
Po Box 9,
Laurel Fork, VA 24352-0009
Ph: (276) 398-1200 | Kelly Russell Burris, NP
109 Carroll Drive,
Fries, VA 24330-4532
Ph: (888) 908-4788 |
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