NPIMap

Individual provider Active NPI

David Kishbaugh, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Fayetteville, NC
National Provider Identifier
1053374157
Registry record updated Feb 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
9500379 Issued in NC
Practice address
2109 Valleygate Dr
Suite 201
Fayetteville, NC 28304-3571
Phone
(910) 486-8880
Fax
(910) 486-8886
NPI assigned
Apr 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 9500379 NC Primary

Addresses

Primary practice location

2109 Valleygate Dr
Suite 201
Fayetteville, NC 28304-3571

Mailing address

PO Box 41054
Fayetteville, NC 28309-1054
Phone (910) 486-8880

Other identifiers 1

IdentifierTypeStateIssuer
8949528MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040811001292 NC Practitioner - Physical Medicine and Rehabilitation 6608761481 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Pennsylvania State University College of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Raleigh Neurosurgical Clinic IncGroup PAC ID 1759315500, 52 clinicians
RPK Center for Rehab, Spine and PainGroup PAC ID 0749279438, 4 clinicians

Practice addresses (Care Compare)

110 Turner St
Southern Pines, NC 28387-7053
Phone (910) 725-0361

2109 Valleygate Dr
Suite 201
Fayetteville, NC 28304-3571
Phone (910) 486-8880

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
27.33 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
91.1

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Raleigh Neurosurgical Clinic, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Raleigh Neurosurgical Clinic, Inc. CurrentSince Jul 1, 2025 Accepting new patients
RPK Center for Rehab, Spine & Pain Physical Medicine & Rehabilitation CurrentSince Jul 1, 2003 Accepting new patients

Locations

1902 N Sandhills Blvd
Ste A
Aberdeen, NC 28315

2109 Valleygate Dr
Ste 201
Fayetteville, NC 28304
Phone (910) 486-8880

5838 Six Forks Rd
Raleigh, NC 27609
Phone (919) 847-1100

5838 Six Forks Rd
Ste 100
Raleigh, NC 27609

110 Turner St
Southern Pines, NC 28387
Phone (910) 725-0361

110 Capcom Ave
Wake Forest, NC 27587
Phone (847) 736-0586

Interoperability endpoints

  • Direct secure messaging: dkishbaugh583221@directhisp.wakemed.org

Organizations & group practices 3

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265846400000",
    "number": "1053374157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41054",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283091054",
            "telephone_number": "910-486-8880",
            "fax_number": "910-486-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 VALLEYGATE DR",
            "address_2": "SUITE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043571",
            "telephone_number": "910-486-8880",
            "fax_number": "910-486-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHBAUGH",
        "first_name": "DAVID",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2010-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NC",
            "license": "9500379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8949528",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.