Individual provider Active NPI

Kayleen Maag

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1760121982
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12784 Issued in NC
Practice address
6019 Oleander Dr
Wilmington, NC 28403-4796
Phone
(910) 332-3800
NPI assigned
Jun 4, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 0010-12784 NC Primary

Addresses

Primary practice location

6019 Oleander Dr
Wilmington, NC 28403-4796

Mailing address

16602 Graham PL
Huntington Beach, CA 92649-3619

Other practice location 1

309 E 2nd St
Pomona, CA 91766-1854
Phone (909) 623-6116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20230127001868 NC Practitioner - Physician Assistant 3870964943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergeortho PAGroup PAC ID 0749188894, 726 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

3787 Shipyard Blvd
Wilmington, NC 28403-6148
Phone (910) 332-3800

6019 Oleander Dr
Suite 200
Wilmington, NC 28403-4813
Phone (910) 790-9714

799 Doctors CT
Roxboro, NC 27573-4571
Phone (336) 599-4079

8066 B Market St
Wilmington, NC 28411-9384
Phone (910) 686-8485

8115 Market St
Suite 108
Wilmington, NC 28411-8429
Phone (910) 332-3800

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

Merit-based Incentive Payment System (MIPS)

Final score
89.07 of 100Reported as group
Quality
85.94
Promoting interoperability
100
Improvement activities
40
Cost
77.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-12784NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergeortho PA CurrentSince Jan 16, 2023 Accepting new patients
Emergeortho PA Physician Assistant CurrentSince Jan 16, 2023 Accepting new patients

Locations

799 Doctors Ct
Roxboro, NC 27573
Phone (336) 599-4079

6019 Oleander Dr
Wilmington, NC 28403
Phone (910) 508-5037

Interoperability endpoints

  • Direct secure messaging: kayleen.maag.1@847.direct.athenahealth.com
  • Direct secure messaging: kmaag1469391@direct.novanthealth.org

Organizations & group practices 2

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 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": "1654300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1760121982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16602 GRAHAM PL",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926493619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284034796",
            "telephone_number": "910-332-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917661854",
            "country_code": "US",
            "telephone_number": "909-623-6116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAAG",
        "first_name": "KAYLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-04",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.