Kirk Porter, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PT2016-011 Issued in AR

Practice address

1107 E Matthews Ave
Suite 200
Jonesboro, AR 72401-4315

Phone

(870) 931-4442

Fax

(870) 802-0205

NPI assigned

Feb 12, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• St Bernards Hospital Inc.

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1396053096
  Medicare reassignment NPD

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

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1366801870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 E MATTHEWS AVE",
            "address_2": "SUITE 200",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014315",
            "telephone_number": "870-931-4442",
            "fax_number": "870-802-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 E MATTHEWS AVE",
            "address_2": "SUITE 200",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014315",
            "telephone_number": "870-931-4442",
            "fax_number": "870-802-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KIRK",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PT2016-011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "212903795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Polston
• Callie Poole, PA-C
• Danielle Faith Poole, DC
• Samantha Pope, PT, DPT
• Shirley Pope
• Lakeya Porter
• Marilyn L Porter, PHD
• Patricia Ann Porter, CNP
• Revel Dean Porter, MD
• Sharon C Porter, QBHP

• Medical Physician Assistant in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.