Individual provider Active NPI

Medhanie Kifle Kifle, PA-C

  • Physician Assistant
  • Newark, OH
National Provider Identifier
1346685807
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2017-0013 Issued in NM
Practice address
1320 W Main St
Newark, OH 43055
Phone
(740) 348-4137
Fax
(740) 348-4119
NPI assigned
May 9, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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 PA2017-0013 NM Primary
Physician Assistant 363A00000X 003744 OH

Addresses

Primary practice location

1320 W Main St
Newark, OH 43055

Mailing address

PO Box 26666
Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20170508000524 NM Practitioner - Physician Assistant 3779702774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

1100 Central Ave SE
Albuquerque, NM 87106-4930
Phone (505) 841-1234

2200 W 21St St
Clovis, NM 88101-2011
Phone (505) 769-7577

2400 Unser Blvd SE
Rio Rancho, NM 87124-3392

2400 Unser Blvd SE
Rio Rancho, NM 87124-4740

8300 Constitution Ave NE
Albuquerque, NM 87110-7613

Hospital & facility affiliations

  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003744OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince May 1, 2017 Accepting new patients
Presbyterian Healthcare Services CurrentSince May 1, 2017 Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients
Licking Memorial Professional Corp. Past Accepting new patients

Locations

3436 Isleta Blvd SW
Albuquerque, NM 87105
Phone (505) 462-7777

8300 Constitution Ave NE
Bldg D
Albuquerque, NM 87110
Phone (505) 291-2200

1100 Lead Ave SE
Albuquerque, NM 87106
Phone (505) 224-7000

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

2400 Unser Blvd SE
Ste 19100
Rio Rancho, NM 87124
Phone (505) 224-7000

2400 Unser Blvd SE
Ste 19100A
Rio Rancho, NM 87124
Phone (505) 224-7000

2400 Unser Blvd SE
Rio Rancho, NM 87124
Phone (505) 253-0000

4801 Beckner Rd
Santa Fe, NM 87507
Phone (505) 772-1234

Interoperability endpoints

  • Direct secure messaging: mkifle107763@direct.phs.org

Organizations & group practices 4

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 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": "1368057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1346685807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "43055",
            "telephone_number": "740-348-4137",
            "fax_number": "740-348-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIFLE",
        "first_name": "MEDHANIE",
        "middle_name": "KIFLE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-09",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2017-0013",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "003744",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.