Individual provider Active NPI

Clint Daniel Kingsley, MD

  • Hematology & Oncology Physician
  • Florence, AL
National Provider Identifier
1053348037
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
25035 Issued in AL
Practice address
180 Cox Creek Pkwy S Ste B
Florence, AL 35630-3263
Phone
(256) 760-0422
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 49477 TN
Hematology & Oncology Physician 207RH0003X 25035 AL Primary

Addresses

Primary practice location

180 Cox Creek Pkwy S Ste B
Florence, AL 35630-3263

Mailing address

PO Box 18428
Huntsville, AL 35804-8428
Phone (256) 705-4224

Other identifiers 10

IdentifierTypeStateIssuer
51012794OtherALBLUE CROSS OF ALABAMA
510-50070OtherALBCBS OF ALABAMA
51547906OtherALBLUE CROSS OF ALABAMA
104703MedicaidAL
102961MedicaidAL
1528883MedicaidTN
510I110169OtherALMEDICARE NUMBER
CA0084OtherALRR MEDICARE
P00657989OtherALRR MEDICARE NUMBER
528701110MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050517000777 AL Practitioner - Hematology/OncologyPractitioner - Internal MedicinePractitioner - Hospice/Palliative Care 5193766491 Reassigns benefits to 1 organization
I20131101001613 TN Practitioner - Hematology/OncologyPractitioner - Hospice/Palliative Care 5193766491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Hospice/Palliative Care, Internal Medicine
Education
University of Alabama School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oncology Specialties, P.C.Group PAC ID 1254328495, 108 clinicians

Practice addresses (Care Compare)

180 Cox Creek Pkwy S
Suite B
Florence, AL 35630-3263
Phone (256) 705-4224

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee Oncology PLLC Hematology & Oncology CurrentSince Oct 1, 2020 Accepting new patients

Locations

1208 Pointe Centre Dr
Ste 110
Chattanooga, TN 37421
Phone (423) 266-4764

979 E 3rd St
Ste A550
Chattanooga, TN 37403
Phone (423) 266-4764

1032 McCallie Ave
Ste 200
Chattanooga, TN 37403
Phone (423) 693-2400

1750 Cedar Ln
Ste 200
Tullahoma, TN 37388
Phone (615) 333-2481

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1053348037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18428",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358048428",
            "telephone_number": "256-705-4224",
            "fax_number": "256-705-4135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 COX CREEK PKWY S STE B",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356303263",
            "telephone_number": "256-760-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGSLEY",
        "first_name": "CLINT",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TN",
            "license": "49477",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AL",
            "license": "25035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ALABAMA",
            "identifier": "51012794",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "510-50070",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ALABAMA",
            "identifier": "51547906",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104703",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102961",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528883",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "510I110169",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CA0084",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "P00657989",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528701110",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, AL

Sources for this page

Verify at the official NPI Registry.