Active NPI
Carroll J. King, M.D., J.D.
- Pediatric Critical Care Medicine Physician
- Columbia, MO
National Provider Identifier
1487753380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 1033
- Practice address
- 404 Keene St
Columbia, MO 65201-6626 - Phone
- (573) 219-4270
- Fax
- (573) 219-4279
- NPI assigned
- Sep 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 40586 | TX | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | 1033 | MO | Primary |
Addresses
Primary practice location
404 Keene St
Columbia, MO 65201-6626
Mailing address
PO Box 7687
Columbia, MO 65205-7687
Phone (573) 219-4270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 169404401 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Juris Doctor, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40586 | TX | MD | General Practice Dentistry |
| 1033 | MO | MD | Pediatric Critical Care Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University at Buffalo Pediatric Associates Inc | Pediatrics | Past | Accepting new patients |
| Utmb Faculty Group Practice | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pediatrics Physician
- Buffalo, NY
- NPI 1912928599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318377600000",
"number": "1487753380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7687",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652057687",
"telephone_number": "573-219-4270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 KEENE ST",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016626",
"telephone_number": "573-219-4270",
"fax_number": "573-219-4279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "CARROLL",
"middle_name": "J.",
"credential": "M.D., J.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-21",
"last_updated": "2011-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "40586",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "MO",
"license": "1033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169404401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.