Kassie Stafford, PA
Individual provider Active NPI Physician Assistant · Pass Christian, MS
NPI 1245567775 · NPPES record last updated Oct 18, 2024
Key facts
- NPI
- 1245567775
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00128 (MS)
- Practice address
- 116 Menge Ave Apt a
Pass Christian, MS 39571-4738 - Phone
- (228) 586-9565
- Fax
- (228) 864-3333
- NPI assigned
- Nov 4, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 61
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Dermatology Clinic, PLLC
Practice addresses (Care Compare)
11295 E Taylor Rd
Gulfport, MS 39503-4197
Phone (228) 864-3300
116 Menge Ave
Suite a
Pass Christian, MS 39571-4712
Phone (228) 864-3300
Hospital & facility affiliations
- Singing River Gulfport
- Memorial Hospital at Gulfport
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.57 of 100
- Quality
- 74.41
- Improvement activities
- 40
- Cost
- 76.03
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100518000215 | MS | Practitioner - Physician Assistant | 5991833675 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00128 | MS | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skin in the Game, PLLC | Past | Accepting new patients |
Interoperability endpoints
- kstafford@directaddress.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.200296 | LA | |
| Physician Assistant | 363A00000X | PA00128 | MS | Yes |
Addresses
Primary practice location
116 Menge Ave Apt a
Pass Christian, MS 39571-4738
Mailing address
11295 E. Taylor Road
Gulfport, MS 39503-4197
Phone (228) 864-3300
Other providers in Pass Christian, MS
- Mark Schmidt
- Rachel N Sims
- Tera Smith
- Sports Medicine LTD
- Donald Lee Sprabery
- Synergy Psychotherapy
- Penny Beth Taggart
- Take Kare Massage & Stretch LLC
- Erika V Tate
- Haley Tutor
All providers in Pass Christian, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.