NPIMap

Individual provider Active NPI

Tom McKibbin-Vaughan, PA

  • Medical Physician Assistant
  • Hudson, NY
National Provider Identifier
1497787584
Registry record updated May 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
009679 Issued in NY
Practice address
2400 US Route 9
Hudson, NY 12534-4725
Phone
(518) 537-4900
Fax
(518) 537-5977
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 009679 NY Primary

Addresses

Primary practice location

2400 US Route 9
Hudson, NY 12534-4725

Mailing address

600 Westage Business Ctr Dr
Fishkill, NY 12524-2281
Phone (845) 231-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20040824000688 NY Practitioner - Physician Assistant 1658345707 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Columbia Memorial Hospital 171 clinicians

Practice addresses (Care Compare)

2827 US Route 9
Valatie, NY 12184-0785
Phone (518) 828-8051

Hospital & facility affiliations

  • Columbia Memorial Hospital Hospital, Hudson, NY, CCN 330094
  • Albany Medical Center Hospital Hospital, Albany, NY, CCN 330013

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
63.01
Promoting interoperability
98
Improvement activities
40
Cost
72.3

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009679NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College CurrentSince Jun 1, 2024 Accepting new patients
Columbia Memorial Hospital CurrentSince Jun 3, 2024 Accepting new patients
Columbia Memorial Hospital CurrentSince Jun 3, 2024 Accepting new patients

Locations

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

10 Grandview Ave
Catskill, NY 12414
Phone (518) 943-9100

283 Mountain View Rd
#2
Copake, NY 12516
Phone (518) 758-7786

71 Prospect Ave
Hudson, NY 12534
Phone (518) 262-3773

117 Marys Ave
Ste 202
Kingston, NY 12401
Phone (845) 338-1717

1275 Broadway
#106
Menands, NY 12204
Phone (518) 262-9705

2827 US Highway 9
Valatie, NY 12184
Phone (518) 828-7601

Interoperability endpoints

  • Direct secure messaging: tmckibbinvaughan101096@albanymed.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273104000000",
    "number": "1497787584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WESTAGE BUSINESS CTR DR",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125242281",
            "telephone_number": "845-231-5600",
            "fax_number": "845-231-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 US ROUTE 9",
            "city": "HUDSON",
            "state": "NY",
            "postal_code": "125344725",
            "telephone_number": "518-537-4900",
            "fax_number": "518-537-5977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIBBIN-VAUGHAN",
        "first_name": "TOM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2010-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "009679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, NY

Sources for this page

Verify at the official NPI Registry.