Individual provider Active NPI

Courtney S Kyle, PA-C

  • Physician Assistant
  • Austin, TX
National Provider Identifier
1033112511
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00470 Issued in TX
Practice address
6000 S. Mopac Expressway, Suite 200
Austin, TX 78749-7874
Phone
(512) 244-4272
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA00470 TX
Physician Assistant 363A00000X PA00470 TX Primary

Addresses

Primary practice location

6000 S. Mopac Expressway, Suite 200
Austin, TX 78749-7874

Mailing address

2000 S Mays St Ste 201
Round Rock, TX 78664-7580
Phone (512) 244-4272

Other practice location 1

2501 W William Cannon Dr
Suite 401
Austin, TX 78745-5281
Phone (512) 416-7246

Other identifiers 2

IdentifierTypeStateIssuer
202347502MedicaidTX
202347505MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031209001038 TX Practitioner - Physician Assistant 7911803069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark Malone MD PAGroup PAC ID 2567369424, 102 clinicians

Practice addresses (Care Compare)

6000 S Mopac
Suite 100
Austin, TX 78749
Phone (512) 244-4272

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00470TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Malone MD PA Physician Assistant CurrentSince Dec 14, 2017 Accepting new patients
Mark Malone, MD PA CurrentSince Dec 14, 2017 Accepting new patients
Texas Orthopedics, Sports & Rehabilitation Associates, PA Past Accepting new patients
Orthopaedic Group, P.a. Past Accepting new patients

Locations

6000 S Mopac Expy
Ste 100
Austin, TX 78749

101 W Louis Henna Blvd
Ste 300
Austin, TX 78728

6000 S Mopac Expy
#200
Austin, TX 78749
Phone (512) 492-3702

1106 College St
Ste C
Bastrop, TX 78602
Phone (512) 244-2895

2000 S Mays St
Ste 201
Round Rock, TX 78664
Phone (512) 492-3743

Interoperability endpoints

  • Direct secure messaging: courtney.kyle.1@24201.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1033112511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S MAYS ST STE 201",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786647580",
            "telephone_number": "512-244-4272",
            "fax_number": "512-275-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 S. MOPAC EXPRESSWAY, SUITE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787497874",
            "telephone_number": "512-244-4272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 W William Cannon Dr",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787455281",
            "country_code": "US",
            "telephone_number": "512-416-7246",
            "fax_number": "512-275-2833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KYLE",
        "first_name": "COURTNEY",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA00470",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202347502",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202347505",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.