CMS-1500 Box 24J / 33a • NPI
1205609187
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LA2100X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care
Box 32 Service Location & ZIP+4
789 CENTRAL AVE, DOVER, NH, 03820-2589
✓ 9-Digit EDI 837 ZIP+4 (03820-2589)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1205609187 (KIMBERLY MCMAHON, APRN) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1205609187)
Medicare Beneficiaries
261
Total Billed Services
473
Distinct CPT/HCPCS Codes
8
Medicare Allowed Total
$32,246.73
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
20553 | Injection of trigger points, 3 or more muscles | 88 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 51 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 322 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Baclofen Baclofen | 15 | <11 |
| Buprenorphine Buprenorphine | 13 | <11 |
| Cyclobenzaprine Hcl Cyclobenzaprine Hcl | 39 | 16 |
| Duloxetine Hcl Duloxetine Hcl | 18 | <11 |
| Gabapentin Gabapentin | 185 | 70 |
| Hydrocodone-Acetaminophen Hydrocodone/Acetaminophen | 59 | 32 |
| Lidocaine Lidocaine | 17 | <11 |
| Methadone Hcl Methadone Hcl | 15 | <11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1205609187 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | KIMBERLY MCMAHON, APRN |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care NUCC Code: 363LA2100X (Nurse Practitioner, Acute Care) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 789 CENTRAL AVE, DOVER, NH, 03820-2589 |
| Practice Telephone / Fax | Tel: (603) 609-6819 |
| Administrative Mailing Address | 117 OLD PINE HILL RD N APT 11, BERWICK, ME, 03901-2979 |
| Enumeration & Last Sync | Enumerated: 2023-11-02 | CMS Record Updated: 2023-11-05 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LA2100X)
What Does Taxonomy Code 363LA2100X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2100X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (KIMBERLY MCMAHON, APRN)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LA2100X — Nurse Practitioner, Acute CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care | State: NH | License: 092662-23 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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