Individual provider Active NPI

Kitty Bonita Sisk, PA-C

  • Physician Assistant
  • Albany, GA
National Provider Identifier
1295885762
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2198 Issued in GA
Practice address
2402 Osler CT
Albany, GA 31707-0205
Phone
(229) 438-3300
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2198 GA Primary

Addresses

Primary practice location

2402 Osler CT
Albany, GA 31707-0205

Mailing address

2402 Osler CT
Albany, GA 31707-0205
Phone (229) 438-3300

Other identifiers 2

IdentifierTypeStateIssuer
0100001200AMedicaidGA
970020094OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20160927002622 GA Practitioner - Physician Assistant 1153618640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

101 Yorktown Dr
Fayetteville, GA 30214-1578

101 Yorktown Dr
Suite 100
Fayetteville, GA 30214-7663
Phone (770) 460-4285

2402 Osler CT
Albany, GA 31707-0205
Phone (229) 438-3300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002198GAMDClinical Social Worker
2198GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Feb 28, 2017 Accepting new patients
Privia Pediatric Medical Group of Georgia LLC Current Accepting new patients
Privia Medical Group South Georgia, LLC Internal Medicine Current Accepting new patients
Sterling Emergency Services of the Southeast Inc Past Accepting new patients

Locations

2402 Osler Ct
Albany, GA 31707
Phone (229) 438-3300

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

950 N Glebe Rd
Ste 4000
Arlington, VA 22203
Phone (301) 593-9011

Organizations & group practices 5

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": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1295885762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 OSLER CT",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317070205",
            "telephone_number": "229-438-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 OSLER CT",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317070205",
            "telephone_number": "229-438-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISK",
        "first_name": "KITTY",
        "middle_name": "BONITA",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "2198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100001200A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970020094",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

Verify at the official NPI Registry.