Song Kang, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085006761 Issued in IN

Practice address

320 E Central Ave
Decatur, IL 62521-4665

Phone

(217) 877-4694

NPI assigned

Oct 1, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Memorial Physician ServicesGroup PAC ID 9032005681, 161 clinicians

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: songok.kangpa.p31@direct.fhn-fqhc.nextgenshare.com

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Memorial Physician Services

  • Family Medicine Physician
  • Springfield, IL
  • NPI 1174877930
  Medicare reassignment Care Compare group
• Family Medical Center of Chatham, LLC

  • Family Medicine Physician
  • Chatham, IL
  • NPI 1992956528
  NPD
• Memorial Physician Services

  • Family Medicine Physician
  • Springfield, IL
  • NPI 1316470651
  NPD
• Memorial Physician Services

  • Rural Health Clinic/Center
  • Jacksonville, IL
  • NPI 1528741147
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Community Health Improvement Center

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1194794917
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Decatur Memorial Hospital

  • General Acute Care Hospital
  • Decatur, IL
  • NPI 1548357973
  Care Compare affiliation

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539129600000",
    "number": "1366927741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3727 N NORTHHAVEN CT APT 2A",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269250",
            "telephone_number": "618-201-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E CENTRAL AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214665",
            "telephone_number": "217-877-4694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "SONG",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "085006761",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "085006761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Michelle Kaloupek, LCSW
• Shahana Kamalenthiran, M.D.
• Amisha Kamath, MD
• Donald Paul Kamm, MD
• Jane A Kamper, CRNA
• Kare4Kids SC
• Amna Karim, MD
• Marla G Karraker, PA-C
• Mikaela Kasperek, PHD, RD
• Komal Kaul, M.D.

• Medical Physician Assistant in Decatur, IL
• Providers in Decatur, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.