KIMBERLY ANNE MCGILLICUDDY (PMH-NP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1255840401
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,192 NURSE PRACTITIONER in IN
Provider Addresses for KIMBERLY ANNE MCGILLICUDDY (PMH-NP)
30 W RAMPART ST SUITE 200
SHELBYVILLE, IN 461768846
Phone: (317) 421-2012
Fax: (317) 398-1851
Type: Mailing
9670 E Washington St Ste 120
Indianapolis, IN 462293051
Phone: (317) 890-5700
Type: Location
120, East Washington Street, Indianapolis, Marion, Indiana, 46204, United States
INDIANAPOLIS, IN 462293051
Phone: (317) 890-5700
Type: Mailing
2451 INTELLIPLEX DR SUITE 260
SHELBYVILLE, IN 461768580
Phone: (317) 398-0121
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 48 Open Payments records for all available years, with a total value of $1,332.
Total Amount is formed as General ($1,332) + Research ($0) + Ownership ($0) = $1,332.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: Supernus Pharmaceuticals, Inc. ($324).
Total Amount
$1,332
General + Research + Ownership
Payments
48
Total payment records
General Amount
$1,332
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2017-10-17
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 |
|---|---|---|---|---|
| I20171017001726 | I | Nurse Practitioner | IN | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46176)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | IN | |
| Nurse Practitioner | IN | |
| Physician Assistant | IL | |
| Mental Health Counselor | IN | |
| Physician Assistant | IN | |
| Nurse Practitioner | IN | |
| Nurse Practitioner | IN | |
| Mental Health Counselor | IN | |
| U R O L O G Y | NH | |
| Nurse Practitioner | IN |
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