NPIMap

Individual provider Active NPI

Mai Khou Vang, PA-C

  • Family Medicine Physician
  • Hickory, NC
National Provider Identifier
1265465819
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
104079 Issued in NC
Practice address
915 Tate Blvd SE
Suite 186
Hickory, NC 28602-4042
Phone
(828) 449-8458
Fax
(828) 323-8348
NPI assigned
Jul 8, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 NU
Family Medicine Physician 207Q00000X 104079 NC Primary

Addresses

Primary practice location

915 Tate Blvd SE
Suite 186
Hickory, NC 28602-4042

Mailing address

915 Tate Blvd SE
Suite 186
Hickory, NC 28602-4042
Phone (828) 449-8458

Other identifiers 1

IdentifierTypeStateIssuer
104079OtherNCLICENSE

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
I20080310000313 NC Practitioner - Physician Assistant 0143305524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
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

Practice roles

OrganizationSpecialtyStatusNew patients
Graystone Family Healthcare PA Family Medicine Current Accepting new patients
DLP Frye Medical Group LLC CurrentSince Jul 3, 2017 Accepting new patients
DLP Central Carolina Physician Practices LLC Family Medicine CurrentSince Aug 1, 2016 Accepting new patients
Fryecare Watauga, LLC Current Accepting new patients
DLP Frye Medical Group LLC Family Medicine Past Accepting new patients
DLP Frye Medical Group LLC Physician Assistant Past Accepting new patients
Graystone Family Healthcare-Tenet North Carolina LLC Family Medicine Past Accepting new patients

Locations

178 Highway 105 Ext
Ste 201
Boone, NC 28607
Phone (828) 262-1800

1105 Fairgrove Church Rd SE
Conover, NC 28613
Phone (828) 267-0551

3511 Graystone Pl SE
Conover, NC 28613
Phone (828) 326-9355

420 N Center St
Hickory, NC 28601
Phone (704) 660-4055

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

915 Tate Blvd SE
Ste 186
Hickory, NC 28602
Phone (828) 449-8458

Interoperability endpoints

  • Direct secure messaging: mai.khou.vang.1@15786.direct.athenahealth.com

Organizations & group practices 7

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 2

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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1265465819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 TATE BLVD SE",
            "address_2": "SUITE 186",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286024042",
            "telephone_number": "828-449-8458",
            "fax_number": "828-323-8348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 TATE BLVD SE",
            "address_2": "SUITE 186",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286024042",
            "telephone_number": "828-449-8458",
            "fax_number": "828-323-8348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANG",
        "first_name": "MAI KHOU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-03-07",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "104079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "104079",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.