Mary Alice Disselkamp, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2407 Ring Rd Ste 108
Elizabethtown, KY 42701-5938

Phone

(270) 706-5787

Fax

(270) 706-5788

NPI assigned

May 14, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiology Associates IncGroup PAC ID 9436045259, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Hardin Hospital, Elizabethtown, KY, CCN 180012

Merit-based Incentive Payment System (MIPS)

Final score

94.29 of 100Reported as apm

Quality

87.32

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

86.26 of 100Reported as group

Quality

100

Improvement activities

40

Cost

54.2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Radiology Associates Inc

  • Diagnostic Radiology Physician
  • Jeffersonville, IN
  • NPI 1851373435

  KY

  Medicare reassignment Care Compare group
• Baptist Health Medical Group Inc

  • Family Medicine Physician
  • Paducah, KY
  • NPI 1922401611

  Physician Assistant

  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  NPD
• Baptist Health Medical Group Inc

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1780961300

  Physician Assistant

  NPD (past)
• Radiology Associates Inc

  • Diagnostic Radiology Physician
  • Lexington, KY
  • NPI 1417697525

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Healthcare System Inc

  • General Acute Care Hospital
  • Elizabethtown, KY
  • NPI 1689282147
  Care Compare affiliation

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1043876170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 RING RD STE 108",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427015938",
            "telephone_number": "270-706-5787",
            "fax_number": "270-706-5788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 RING RD STE 108",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427015938",
            "telephone_number": "270-706-5787",
            "fax_number": "270-706-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISSELKAMP",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-14",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne M Deville, LMT
• Stacyia N Dillard
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• Scott Dishaw, MD
• Jenna Leigh Dismore Wrinkles, M.D.
• Rodney Earl Dixon, CRNA
• Wanda Carpenter Dobbins, LCSW
• Dolphin Hills Family Healthcare
• David Thomas Dolwig, DC
• Jessica Lee Donahue, RDH

• Physician Assistant in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.