NPIMap

Individual provider Active NPI

Kristin Davis Campbell, PA-C

  • Physician Assistant
  • Tifton, GA
National Provider Identifier
1407064090
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005040 Issued in GA
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 353-6051
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005040 GA Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

907 18TH St E Ste 400
Tifton, GA 31794-3684
Phone (229) 353-6051

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kristin.campbell@trhs.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20080218000007 GA Practitioner - Physician Assistant 1557444312 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

2225 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 391-4100

2227 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 353-6188

901 18TH St E
Tifton, GA 31794-3648
Phone (229) 382-7120

Hospital & facility affiliations

  • Tift Regional Medical Center Hospital, Tifton, GA, CCN 110095

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System Inc CurrentSince Apr 1, 2020 Accepting new patients
Tift Regional Health System Inc CurrentSince Apr 1, 2010 Accepting new patients
Hospital Authority of Ben Hill CurrentSince Apr 1, 2008 Accepting new patients
Tift Regional Health System Inc CurrentSince Apr 1, 2020 Accepting new patients
Hospital Authority of Ben Hill CurrentSince Apr 1, 2008 Accepting new patients
Tift Regional Health System Inc. Past Accepting new patients

Locations

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

200 Perry House Rd
Fitzgerald, GA 31750
Phone (229) 424-1461

907 18th St E
Ste 150
Tifton, GA 31794
Phone (229) 353-3422

907 18th St E
Ste 400
Tifton, GA 31794

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

Interoperability endpoints

  • Direct secure messaging: kristin.campbell@trhs.cernerdirect.com

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 1

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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1407064090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E STE 400",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943684",
            "telephone_number": "229-353-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-353-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KRISTIN",
        "middle_name": "DAVIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristin.campbell@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "901 18th St E",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317943648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.