Kayla Lynn Shattuck, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4398 Issued in SC

Practice address

100 Omni Dr Ste B
Seneca, SC 29672-9448

Phone

(864) 886-9250

Fax

(864) 886-9251

NPI assigned

Oct 19, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kayla Lynn Mizgala Former name

Medicare fee-for-service enrollment

Enrolled in NY, SC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prisma Health Oconee Memorial Hospital Hospital, Seneca, SC, CCN 420009

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kshattuck723751@direct.ghs.myhfn.org

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.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment Care Compare group NPD (past)
• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  Medicare reassignment
• St. Joseph's Physician Health, P.C.

  • Anesthesiology Physician
  • Troy, NY
  • NPI 1154376770
  Medicare reassignment
• Prisma Health University Medical Group

  dba Parkside OB-GYN

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Prisma Health University Medical Group

  dba Eastside Pediatrics, PA

  • Pediatrics Physician
  • Taylors, SC
  • NPI 1801524392
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prisma Health-Upstate

  dba Prisma Health Oconee Memorial Hospital

  • General Acute Care Hospital
  • Seneca, SC
  • NPI 1063968196
  Care Compare affiliation
• Prisma Health-Upstate

  dba Prisma Health Center For Family Medicine-Oconee

  • Clinic/Center
  • Seneca, SC
  • NPI 1407345846

  Hospital

  Care Compare affiliation
• Prisma Health-Upstate

  dba Prisma Health Oconee Pain Management

  • Pain Clinic/Center
  • Seneca, SC
  • NPI 1891237632

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1445212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1629449483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 OMNI DR STE B",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296729448",
            "telephone_number": "864-886-9250",
            "fax_number": "864-886-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "KAYLA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-19",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "MIZGALA",
            "middle_name": "LYNN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Seneca Pharmacy, LLC (Seneca Pharmacy)
• Senior Solutions
• Natally Ann Shadwick, RN.
• Ann Margaret Shalley, M.D.
• Shaping Lives Counseling LLC
• Grant Shealy
• Stephanie King Shepherd, MA
• Lexus Shew
• Susan Shipley
• Tanner Shirley, LPC

• Physician Assistant in Seneca, SC
• Providers in Seneca, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.