NPIMap

Individual provider Active NPI

Michael Kitson Kaczmarek, M.D.

  • Emergency Medicine Physician
  • Concord, NC
National Provider Identifier
1376591149
Registry record updated Nov 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
200501956 Issued in NC
Practice address
1028 Lee Ann Dr NE
Suite 200
Concord, NC 28025-2911
Phone
(704) 782-1892
NPI assigned
May 4, 2006
Last updated
Nov 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 200501956 NC Primary

Addresses

Primary practice location

1028 Lee Ann Dr NE
Suite 200
Concord, NC 28025-2911

Mailing address

1028 Lee Ann Dr NE
Suite 200
Concord, NC 28025-2911
Phone (704) 782-1892

Other identifiers 3

IdentifierTypeStateIssuer
5903304MedicaidNC
225474MedicaidSC
141V9OtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140422001508 SC Practitioner - Emergency Medicine 4981612736 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
200501956NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Abbeville County Memorial Hospital CurrentSince Sep 25, 2024 Accepting new patients
St Francis Hospital Inc Emergency Medicine CurrentSince Jan 25, 2014 Accepting new patients
Vituity-South Carolina LLC Emergency Medicine CurrentSince Jan 1, 2021 Accepting new patients
Self Medical Group CurrentSince Apr 1, 2023 Accepting new patients
St. Francis Hospital, Inc. Current Accepting new patients
St Francis Hospital Inc CurrentSince Jan 25, 2014 Accepting new patients
Self Medical Group CurrentSince Apr 1, 2023 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Sep 25, 2024 Accepting new patients
Starting Point of Florence, Inc CurrentSince Jan 22, 2024 Accepting new patients
Self Medical Group Current Accepting new patients
Self Regional Healthcare Past Accepting new patients
Bamberg County Memorial Hospital Past Accepting new patients
Self Regional Healthcare Past Accepting new patients
Cabarrus Emergency Medicine Associates, P.a. Emergency Medicine Past Accepting new patients
Greenville Health System Past Accepting new patients
Emergency Physician Services Past Accepting new patients

Locations

75 Remittance Dr
Dept 1363
Chicago, IL 60675

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6875
Chicago, IL 60675

420 Thomson Cir
Abbeville, SC 29620
Phone (864) 366-1649

300 Ridge Medical Plaza Rd
Edgefield, SC 29824
Phone (803) 637-3174

1 Saint Francis Dr
Greenville, SC 29601
Phone (864) 225-1000

125 Commonwealth Dr
Greenville, SC 29615
Phone (864) 225-1800

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: mkaczmarek70278@selfregional.direct-ci.net

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 16

Hospital & facility affiliations 4

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384992000000",
    "number": "1376591149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 LEE ANN DR NE",
            "address_2": "SUITE 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252911",
            "telephone_number": "704-782-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 LEE ANN DR NE",
            "address_2": "SUITE 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252911",
            "telephone_number": "704-782-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZMAREK",
        "first_name": "MICHAEL",
        "middle_name": "KITSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2013-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200501956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903304",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225474",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "141V9",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.