Shannon Marie Kimmel, in Charlotte, NC - Medicare Nurse Practitioner

Shannon Marie Kimmel, is a medicare enrolled "Nurse Practitioner - Family" in Charlotte, North Carolina. Her current practice location is 9200 Glenwater Dr, Charlotte, North Carolina. You can reach out to her office (for appointments etc.) via phone at (901) 603-8704.

Shannon Marie Kimmel is licensed to practice in North Carolina (license number 5018442) 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 1104505890.

Contact Information

	Shannon Marie Kimmel,
	9200 Glenwater Dr, Charlotte, NC 28262-8557
	(901) 603-8704
	Not Available

Map and Direction

Provider's Profile

Full Name	Shannon Marie Kimmel
Gender	Female
Speciality	Nurse Practitioner - Family
Location	9200 Glenwater Dr, Charlotte, North Carolina
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1104505890
Provider Enumeration Date: 07/12/2023
Last Update Date: 09/26/2025

Medicare PECOS Information:

PECOS PAC ID: 1052758851
Enrollment ID: I20240327003789

Medical Identifiers

Medical identifiers for Shannon Marie Kimmel such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1104505890	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	5018442 (North Carolina)	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. Shannon Marie Kimmel allows following entities to bill medicare on her behalf.

Entity Name	Kinetic Medical Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1285228585 PECOS PAC ID: 5294141909 Enrollment ID: O20240326000233

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. Shannon Marie Kimmel 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
Shannon Marie Kimmel, 6304 Durango Way, Denver, NC 28037-1429 Ph: (989) 600-5371	Shannon Marie Kimmel, 9200 Glenwater Dr, Charlotte, NC 28262-8557 Ph: (901) 603-8704

Reviews and Comments

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Shannon Marie Kimmel, - Medicare Nurse Practitioner in Charlotte, NC