NPIMap

Individual provider Active NPI

Terry D Kinney, PA-C

  • Physician Assistant
  • Red Bluff, CA
National Provider Identifier
1194869883
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18663 Issued in CA
Practice address
645 Antelope Blvd
Suite # 24
Red Bluff, CA 96019
Phone
(530) 528-7650
Fax
(530) 528-7655
NPI assigned
Feb 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60316881 WA
Physician Assistant 363A00000X PA18663 CA Primary

Addresses

Primary practice location

645 Antelope Blvd
Suite # 24
Red Bluff, CA 96019

Mailing address

707 S Grady Way
Ste 600
Renton, WA 98057-3227
Phone (206) 823-1004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20140210001083 WA Practitioner - Physician Assistant 6507962354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

9601 Steilacoom Blvd SW
BLDG 27
Lakewood, WA 98498-7212
Phone (253) 589-5334

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA18663CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Telecare Mental Health Services of Washington, Inc. CurrentSince Oct 17, 2015 Accepting new patients
Metropolitan Development Council Past Accepting new patients
Telecare Mental Health Services of Washington, Inc. Past Accepting new patients
Metropolitan Development Council Past Accepting new patients
Tacoma Detoxification Center Past Accepting new patients
Telecare Mental Health Services of Washington, Inc. Past Accepting new patients
Telecare Mental Health Services of Washington, Inc Past Accepting new patients

Locations

1080 Marina Village Pkwy
Ste 100
Alameda, CA 94501
Phone (510) 306-5660

3285 Ferguson St SW
Tumwater, WA 98512
Phone (360) 252-2989

Interoperability endpoints

  • Direct secure messaging: advancedmentalhealthofwa.terrykinney159776.advancedmd-direct.com@159776.advancedmd-direct.com

Organizations & group practices 8

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": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1194869883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S GRADY WAY",
            "address_2": "STE 600",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980573227",
            "telephone_number": "206-823-1004",
            "fax_number": "206-309-3319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 ANTELOPE BLVD",
            "address_2": "SUITE # 24",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "96019",
            "telephone_number": "530-528-7650",
            "fax_number": "530-528-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNEY",
        "first_name": "TERRY",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60316881",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bluff, CA

Sources for this page

Verify at the official NPI Registry.