Mimi Ann Kingery, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9106214 Issued in FL

Practice address

5147 N 9TH Ave Ste 311
Pensacola, FL 32504-8770

Phone

(850) 477-2597

Fax

(850) 478-7941

NPI assigned

Aug 18, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL, MO2 enrollments

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 2

Specialty

Physician Assistant

Education

University of South Alabama College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Missouri Hospital Physicians LLCGroup PAC ID 9133024334, 206 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
• Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025

Merit-based Incentive Payment System (MIPS)

Final score

76.51 of 100Reported as group

Quality

51.13

Promoting interoperability

94

Improvement activities

40

Cost

75.56

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Southeast Missouri Hospital Physicians, LLC

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522
  Medicare reassignment Care Compare group
• Gastroenterology Associates of Pensacola PA

  • Gastroenterology Physician
  • Pensacola, FL
  • NPI 1235223785
  Medicare reassignment NPD
• Gastroenterology Associates of Pensacola PA

  • Certified Registered Nurse Anesthetist
  • Pensacola, FL
  • NPI 1972697936
  NPD
• Southeast Health Center of Stoddard County LLC

  • Family Medicine Physician
  • Dexter, MO
  • NPI 1477997567
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sacred Heart Health System, Inc.

  • General Acute Care Hospital
  • Pensacola, FL
  • NPI 1922032424
  Care Compare affiliation
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1313625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1790065035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4828 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032341",
            "telephone_number": "850-477-8109",
            "fax_number": "850-478-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5147 N 9TH AVE STE 311",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048770",
            "telephone_number": "850-477-2597",
            "fax_number": "850-478-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGERY",
        "first_name": "MIMI",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-18",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000132945",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y08Z7",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR",
            "identifier": "FO262Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin A. King, LMT
• Lawrence King III, M.D.
• Thomas I King, MD
• Walter Barnett King Jr., O.D.
• Caitlin Kingan, MS
• Kam Kingsland, APRN, PMHNP
• Nicole Marie Kinnard, BCBA
• Andrea Kinney, LMT
• Curstin Kinsey, PA-C
• Brian Scott Kirby, M.D.

• Medical Physician Assistant in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.