Individual provider Active NPI

Kyle D Horner, PA-C

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1295903342
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06049 Issued in NC
Practice address
2800 Blue Ridge Rd Ste 400
Raleigh, NC 27607-6477
Phone
(919) 787-5380
Fax
(919) 787-3415
NPI assigned
Feb 12, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9104485 FL
Physician Assistant 363A00000X 0010-06049 NC Primary

Addresses

Primary practice location

2800 Blue Ridge Rd Ste 400
Raleigh, NC 27607-6477

Mailing address

1000 Hollymont Dr
Holly Springs, NC 27540-5965
Phone (317) 508-3950

Other practice location 1

2800 Blue Ridge Rd
Suite 201
Raleigh, NC 27607-6478
Phone (919) 784-7110

Other identifiers 2

IdentifierTypeStateIssuer
230482OtherFLAMERIGROUP
33803AOtherGROUP MEDICARE NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address khorner167665@direct.UNC.nchie.net Direct

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
I20160401001187 NC Practitioner - Physician Assistant 9739268194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

4420 Lake Boone TRL
Raleigh, NC 27607-7505

850 S Main St
Holly Springs, NC 27540-8906
Phone (984) 215-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0010-06049NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rex Hospital Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: khorner167665@direct.unc.nchie.net

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 and National Provider Directory roles.

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": "1202774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1295903342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HOLLYMONT DR",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275405965",
            "telephone_number": "317-508-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 BLUE RIDGE RD STE 400",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076477",
            "telephone_number": "919-787-5380",
            "fax_number": "919-787-3415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Blue Ridge Rd",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276076478",
            "country_code": "US",
            "telephone_number": "919-784-7110",
            "fax_number": "919-784-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HORNER",
        "first_name": "KYLE",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-12",
        "last_updated": "2021-04-21",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9104485",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "230482",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE NUMBER",
            "identifier": "33803A",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khorner167665@direct.UNC.nchie.net",
            "affiliation": "N",
            "endpointDescription": "Direct",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2800 Blue Ridge Rd Ste 400",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276076477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.