KATHLEEN BOURNIVAL (NP) – Family Nurse Practitioner, NPI 1679667661
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
24,232 NURSE PRACTITIONER in FL
Provider Addresses for KATHLEEN BOURNIVAL (NP)
3131 DANIELS RD STE 106
WINTER GARDEN, FL 347877013
Phone: (074) 200-4776
Type: Mailing
3131 DANIELS RD
WINTER GARDEN, FL 347877013
Phone: (407) 200-4776
Fax: (407) 303-0580
Type: Location
1595, Bridge Street, Dracut, Middlesex County, Massachusetts, 01826, United States
SUITE 3
DRACUT, MA 018262614
Phone: (978) 323-2808
Fax: (978) 323-2810
Type: Mailing
1574, Main Street, Tewksbury, Middlesex County, Massachusetts, 01876, United States
TEWKSBURY, MA 018762067
Phone: (978) 323-2819
Fax: (978) 323-2821
Type: Location
3115 CITRUS TOWER BLVD STE A
CLERMONT, FL 347116880
Phone: (352) 394-4237
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $204.
Total Amount is formed as General ($204) + Research ($0) + Ownership ($0) = $204.
Last reported payment date: 2024-08-01 • Largest payer in this snapshot: Novo Nordisk Inc ($94).
Total Amount
$204
General + Research + Ownership
Payments
10
Total payment records
General Amount
$204
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-01
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $94 |
| Lilly USA, LLC | $67 |
| Exact Sciences Corporation | $22 |
| GlaxoSmithKline, LLC. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-12-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20211220001513 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 48 | 30 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 12 | 12 | $0 |
Insurance plans in this area (ZIP 34787)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | FL | |
| Nurse Practitioner | FL |
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