Individual provider Active NPI

Kevin Edward McMahon, PA-C

  • Medical Physician Assistant
  • Hickory, NC
National Provider Identifier
1205809118
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
103167 Issued in NC
Practice address
2660 Tate Blvd SE
Hickory, NC 28602-1465
Phone
(828) 261-0009
NPI assigned
Feb 10, 2006
Last updated
Oct 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 103167 NC Primary

Addresses

Primary practice location

2660 Tate Blvd SE
Hickory, NC 28602-1465

Mailing address

2660 Tate Blvd SE
Hickory, NC 28602-1465
Phone (828) 261-0009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100226000422 NC Practitioner - Physician Assistant 1658416862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Hahneman Medical College of the Pacific, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DLP Frye Medical Group LLCGroup PAC ID 8123397601, 125 clinicians

Practice addresses (Care Compare)

915 Tate Blvd SE
Hickory, NC 28602-4042

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5724NCMDChiropractor
103167NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Frye Medical Group LLC CurrentSince Jun 1, 2017 Accepting new patients
Cardiology Physicians Associates Past Accepting new patients

Locations

2660 Tate Blvd SE
Hickory, NC 28602
Phone (828) 261-0009

915 Tate Blvd SE
Ste 182
Hickory, NC 28602
Phone (828) 322-2005

602 Morganton Blvd SW
Lenoir, NC 28645
Phone (828) 239-9400

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1205809118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2660 TATE BLVD SE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286021465",
            "telephone_number": "828-261-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2660 TATE BLVD SE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286021465",
            "telephone_number": "828-261-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMAHON",
        "first_name": "KEVIN",
        "middle_name": "EDWARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.