William Blake McKibbin, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

0101240500 Issued in VA

Practice address

16 Ivy Ridge LN Ste 130
Fishersville, VA 22939-2354

Phone

(540) 332-5909

Fax

(540) 332-5910

NPI assigned

Jun 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, MS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Surgery

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bolivar Physician Practices LLCGroup PAC ID 6305995895, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bolivar Medical Center Hospital, Cleveland, MS, CCN 250093
• North Sunflower Medical Center Cah Hospital, Ruleville, MS, CCN 251318

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: william.mckibbin.1@10381.direct.athenahealth.com
• Direct secure messaging: bke3548@yourcarecommunity.org

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.

• Bolivar Physician Practices LLC

  • Orthopaedic Surgery Physician
  • Cleveland, MS
  • NPI 1063659530
  Medicare reassignment Care Compare group NPD
• Bolivar Physician Practices LLC

  • Rural Health Clinic/Center
  • Rosedale, MS
  • NPI 1205489689
  NPD
• Bolivar Physician Practices LLC

  • Family Medicine Physician
  • Cleveland, MS
  • NPI 1376787556
  NPD
• CMH Surgical Services, LLC

  • Surgery Physician
  • South Hill, VA
  • NPI 1942245337
  NPD (past)
• Bolivar Physician Practices LLC

  • Family Medicine Physician
  • Cleveland, MS
  • NPI 1043454655
  NPD (past)

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

• North Sunflower Medical Center

  • Critical Access Hospital
  • Ruleville, MS
  • NPI 1508913609
  Care Compare affiliation
• PHC-Cleveland LLC

  • General Acute Care Hospital
  • Cleveland, MS
  • NPI 1457321036
  Care Compare affiliation

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1295739878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 IVY RIDGE LN STE 130",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392354",
            "telephone_number": "540-332-5909",
            "fax_number": "540-332-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 IVY RIDGE LN STE 130",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392354",
            "telephone_number": "540-332-5909",
            "fax_number": "540-332-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIBBIN",
        "first_name": "WILLIAM",
        "middle_name": "BLAKE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "052784",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101240500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "705155309A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jay A. McDonald, M.D.
• Kara McGill-Meeks, RD
• Sarah E McGill, NP
• Rachel Anne McGirl
• Douglas William McKibbin, M.D.
• Kathryn Elliot McKinney, MSN, CNM, APRN
• Robert W. McMahon, MD
• Mary G. McMasters
• Daniel Burnes McMillan, M.D.
• George R McNair, M.D.

• Surgery Physician in Fishersville, VA
• Providers in Fishersville, VA by specialty
• Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.