Kathy Song, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1287 Issued in AL

Practice address

356110 E 930 Rd
Stroud, OK 74079-5184

Phone

(918) 968-9531

NPI assigned

Sep 17, 2012

Last updated

Sep 3, 2019By the provider in NPPES

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 AL

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

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cypress Healthcare, LLC

  dba Alabama Pain Physicians

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Vestavia, AL
  • NPI 1811295215
  Medicare reassignment NPD

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1396095360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2868 ACTON RD",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352432502",
            "telephone_number": "205-379-6075",
            "fax_number": "866-702-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "356110 E 930 RD",
            "city": "STROUD",
            "state": "OK",
            "postal_code": "740795184",
            "telephone_number": "918-968-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "KATHY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "1287",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2160",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margala Ann Sell, APRN-CNS
• Serenity Care LLC
• Shawnee Medical Center Clinic, Inc (St Anthony Physicians-Stroud Family Medicine)
• Karry L Simpson, PT
• Camaron Eugene Snider, PHARMD
• Briana Lynn Spirlock, PHARMD
• Stroud Drug Holding LLC (Stroud Drug LTC)
• Stroud Drug Inc (Stroud Drug)
• Stroud Nursing & Rehab LLC (Stroud Nursing & Rehab)
• Stroud Regional Medical Center LLC (Stroud Regional Medical Center)

• Medical Physician Assistant in Stroud, OK
• Providers in Stroud, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.