NPIMap

Organization Active NPI

Kingsley Clinic PLLC

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1770143315
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
KINGSLEY CLINIC PLLC
Practice address
14180 Dallas Pkwy Ste 620
Dallas, TX 75254-4363
Phone
(530) 305-7637
NPI assigned
Jun 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Dr. James Ralph Kingsley Jr., MDNPI 1841687142
Title
Chief Executive Officer
Phone
(530) 305-7637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

14180 Dallas Pkwy Ste 620
Dallas, TX 75254-4363

Mailing address

33471 Biltmore Dr
Temecula, CA 92592-1849
Phone (530) 305-7637

Other identifiers 1

IdentifierTypeStateIssuer
R2380OtherTXSTATE MEDICAL LICENSE

Other names 1

  • The Kingsley Clinic PLLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY, IL, OH, PA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20200610000408 TX Part B Supplier - Clinic/Group Practice 7113348616 Receives reassigned benefits from 26 practitioners
Practice locations: Dallas, TX
O20230323002447 NY Part B Supplier - Clinic/Group Practice 7113348616 Receives reassigned benefits from 2 practitioners
Practice locations: White Plains, NY
O20230825002311 IL Part B Supplier - Clinic/Group Practice 7113348616 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL
O20250114001024 OH Part B Supplier - Clinic/Group Practice 7113348616 Receives reassigned benefits from 1 practitioner
Practice locations: Cincinnati, OH
O20250211000315 PA Part B Supplier - Clinic/Group Practice 7113348616 Receives reassigned benefits from 1 practitioner
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

250 E 5th St
#15
Cincinnati, OH 45202

14180 Dallas Pkwy
Dallas, TX 75254
Phone (469) 391-0070

14180 Dallas Pkwy
Ste 620
Dallas, TX 75254
Phone (469) 391-0070

5501 Independence Pkwy
Ste 301
Plano, TX 75023

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1770143315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33471 BILTMORE DR",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925921849",
            "telephone_number": "530-305-7637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14180 DALLAS PKWY STE 620",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752544363",
            "telephone_number": "530-305-7637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSLEY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "KINGSLEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "RALPH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "530-305-7637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "R2380",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Kingsley Clinic PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.