MRS. KOURTNEY INGRAM (AGACNP-BC) – Adult Health Nurse Practitioner, NPI 1801561089
Adult Health Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. KOURTNEY INGRAM (AGACNP-BC)
104 PRINCE PLAZA DR
BONAIRE, GA 310054212
Phone: (478) 235-8655
Type: Mailing
654 1ST ST
MACON, GA 312012851
Phone: (478) 738-9443
Type: Location
520 GA HIGHWAY 247 S # 160
BONAIRE, GA 310053886
Phone: (478) 403-3295
Type: Mailing
4501 RUSSELL PKWY STE 31
WARNER ROBINS, GA 310888681
Phone: (478) 403-3295
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $47.
Total Amount is formed as General ($47) + Research ($0) + Ownership ($0) = $47.
Last reported payment date: 2023-07-18 • Largest payer in this snapshot: SCPHARMACEUTICALS INC. ($16).
Total Amount
$47
General + Research + Ownership
Payments
3
Total payment records
General Amount
$47
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| SCPHARMACEUTICALS INC. | $16 |
| Boston Scientific Corporation | $16 |
| Lilly USA, LLC | $15 |
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: 2021-10-16
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 |
|---|---|---|---|---|
| I20211016000017 | I | Nurse Practitioner | GA | 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 31005)
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