NPIMap

Individual provider Active NPI

Kyungran Gibson, PA-C

  • Physician Assistant
  • Portsmouth, NH
National Provider Identifier
1649897372
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1679 Issued in NH
Practice address
330 Borthwick Ave Ste 311
Portsmouth, NH 03801-7112
Phone
(603) 692-2228
Fax
(603) 692-4748
NPI assigned
Jun 29, 2020
Last updated
Nov 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

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 1679 NH Primary

Addresses

Primary practice location

330 Borthwick Ave Ste 311
Portsmouth, NH 03801-7112

Mailing address

21 Clark Way
Somersworth, NH 03878-4401
Phone (603) 692-2228

Other names 1

  • Kathy Gibson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20210127003269 NH Practitioner - Physician Assistant 4082028378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlantic Digestive Specialists PLLCGroup PAC ID 0941198329, 17 clinicians

Practice addresses (Care Compare)

21 Clark Way
Somersworth, NH 03878-4401
Phone (603) 692-2228

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1679NHMDDentist

Interoperability endpoints

  • Direct secure messaging: kgibson@atlanticdigestive.directbygreenway.com

Organizations & group practices 1

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 12

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": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1649897372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CLARK WAY",
            "city": "SOMERSWORTH",
            "state": "NH",
            "postal_code": "038784401",
            "telephone_number": "603-692-2228",
            "fax_number": "603-692-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BORTHWICK AVE STE 311",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017112",
            "telephone_number": "603-692-2228",
            "fax_number": "603-692-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KYUNGRAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHY",
            "last_name": "GIBSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portsmouth, NH

Sources for this page

Verify at the official NPI Registry.