Individual provider Active NPI

Rosa Kim Young, PA-C

  • Physician Assistant
  • Moore, OK
National Provider Identifier
1730755265
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4594 Issued in OK
Practice address
1060 SW 4TH St
Moore, OK 73160-2494
Phone
(405) 302-2661
NPI assigned
Jun 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 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 4594 OK Primary

Addresses

Primary practice location

1060 SW 4TH St
Moore, OK 73160-2494

Mailing address

1060 SW 4TH St
Moore, OK 73160-2494
Phone (405) 302-2661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210719000578 OK Practitioner - Physician Assistant 3971905654 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1060 SW 4TH St
Moore, OK 73160-2494
Phone (405) 378-5491

4120 W Memorial Rd
Suite 205
Oklahoma City, OK 73120-9322
Phone (405) 749-4205

4120 W Memorial Rd
Suite 218
Oklahoma City, OK 73120-9320
Phone (405) 302-2661

4300 McAuley Blvd
Oklahoma City, OK 73120-8302
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120-8304
Phone (405) 755-1515

Hospital & facility affiliations

  • Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013
  • Norman Regional Hospital, Norman, OK, CCN 370008

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rtran1177847@directc.mercy.net

Organizations & group practices 3

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 2

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": "1622678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1730755265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 SW 4TH ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602494",
            "telephone_number": "405-302-2661",
            "fax_number": "405-302-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 SW 4TH ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602494",
            "telephone_number": "405-302-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ROSA",
        "middle_name": "KIM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-03",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "4594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.