NPIMap

Individual provider Active NPI

Kyle King, PAC

  • Physician Assistant
  • Marquette, MI
National Provider Identifier
1609408442
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010252 Issued in MI
Practice address
1414 W Fair Ave Ste 334
Marquette, MI 49855-5407
Phone
(906) 225-4500
NPI assigned
Feb 10, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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 5601010252 MI Primary

Addresses

Primary practice location

1414 W Fair Ave Ste 334
Marquette, MI 49855-5407

Mailing address

1414 W Fair Ave Ste 334
Marquette, MI 49855-5407
Phone (906) 225-4500

Other practice location 1

1280 E Campus Dr
MT Pleasant, MI 48859-2033
Phone (989) 774-2478

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20201229002435 MI Practitioner - Physician Assistant 3870906357 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Central Michigan College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dickinson County Healthcare System 103 clinicians

Practice addresses (Care Compare)

1721 S Stephenson Ave
Iron Mountain, MI 49801-3637
Phone (906) 774-1313

Hospital & facility affiliations

  • Uphs Marquette DLP Hospital Hospital, Marquette, MI, CCN 230054
  • Dickinson County Memorial Hospital Hospital, Iron Mountain, MI, CCN 230055

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601010252MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dickinson County Healthcare System Physician Assistant CurrentSince Mar 28, 2023 Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
Alzheimer'S Disease and Related Disorders Association, Inc PastSince Jan 13, 2017 Accepting new patients
Dickinson County Healthcare System Past Accepting new patients

Locations

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

1414 W Fair Ave
Ste 334
Marquette, MI 49855
Phone (906) 225-3870

Interoperability endpoints

  • Direct secure messaging: kyle.king@marshfieldclinichealthsystem.cernerdirect.com
  • Direct secure messaging: him@marshfieldclinichealthsystem.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": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1609408442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 334",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555407",
            "telephone_number": "906-225-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 334",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555407",
            "telephone_number": "906-225-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1280 E Campus Dr",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "MI",
            "postal_code": "488592033",
            "country_code": "US",
            "telephone_number": "989-774-2478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "KYLE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-10",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1414 W Fair Ave Ste 334",
            "city": "Marquette",
            "state": "MI",
            "country_code": "US",
            "postal_code": "498555407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

Verify at the official NPI Registry.