NPIMap

Organization Active NPI

Kamm McKenzie OBGYN, PLLC

  • Obstetrics & Gynecology Physician
  • Raleigh, NC
National Provider Identifier
1316900780
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
KAMM MCKENZIE OBGYN, PLLC
Practice address
3805 Computer Drive
Raleigh, NC 27609
Phone
(919) 781-6200
Fax
(919) 783-1819
NPI assigned
Apr 7, 2006
Last updated
Jul 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Authorized official

Name
Kristin Flyod
Title
Director of Administration
Phone
(919) 781-2275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NC Primary

Addresses

Primary practice location

3805 Computer Drive
Raleigh, NC 27609

Mailing address

3805 Computer Drive
Raleigh, NC 27609-6503
Phone (919) 781-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050908000474 NC Part B Supplier - Clinic/Group Practice 9537191788 Receives reassigned benefits from 17 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

2011 Falls Valley Dr
#103
Raleigh, NC 27615
Phone (919) 781-6200

3805 Computer Dr
Raleigh, NC 27609
Phone (919) 781-6200

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1316900780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 COMPUTER DRIVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096503",
            "telephone_number": "919-781-6200",
            "fax_number": "919-783-1819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 COMPUTER DRIVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27609",
            "telephone_number": "919-781-6200",
            "fax_number": "919-783-1819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAMM MCKENZIE OBGYN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "FLYOD",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "919-781-2275"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.