NPIMap

Individual provider Active NPI

Jessica S King, DO

  • Family Medicine Physician
  • Champlain, NY
National Provider Identifier
1649615923
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
279899 Issued in NY
Practice address
481 Route 11
Champlain, NY 12919-4819
Phone
(518) 298-2691
Fax
(518) 298-8241
NPI assigned
May 1, 2013
Last updated
Feb 7, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 279899 NY Primary

Addresses

Primary practice location

481 Route 11
Champlain, NY 12919-4819

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other identifiers 1

IdentifierTypeStateIssuer
04385342MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20220503002192 ME Practitioner - Family Practice 9638464340 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

146 Weld St
Dixfield, ME 04224-9614
Phone (207) 795-7584

420 Franklin St
Rumford, ME 04276-2104

430 Franklin St
Rumford, ME 04276-2104
Phone (207) 369-1224

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.94 of 100Reported as group
Quality
47.72
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.57 of 100Reported as group
Quality
66.56
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Central Maine Medical Center CurrentSince Jun 8, 2023 Accepting new patients
Rumford Hospital CurrentSince Apr 22, 2023 Accepting new patients
Rumford Community Family Health Center, Inc. Current Accepting new patients
Central Maine Medical Center CurrentSince Jun 8, 2023 Accepting new patients
Rumford Community Family Health Center Inc. CurrentSince Jan 26, 2022 Accepting new patients
Rumford Community Family Health Center, Inc. CurrentSince Jan 26, 2022 Accepting new patients
Rumford Hospital CurrentSince Apr 22, 2023 Accepting new patients
Hudson Headwaters Health Network PastSince Aug 15, 2016 Accepting new patients

Locations

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

31 Campus Ave
Lewiston, ME 04240
Phone (207) 786-6199

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

430 Franklin St
Rumford, ME 04276
Phone (207) 369-0146

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1649615923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 ROUTE 11",
            "city": "CHAMPLAIN",
            "state": "NY",
            "postal_code": "129194819",
            "telephone_number": "518-298-2691",
            "fax_number": "518-298-8241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "JESSICA",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-01",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "279899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04385342",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlain, NY

Sources for this page

Verify at the official NPI Registry.