Mary R King, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00646 Issued in MS

Practice address

11295 E Taylor Rd
Gulfport, MS 39503-4197

Phone

(228) 864-3300

Fax

(228) 864-3333

NPI assigned

Mar 17, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL, MS2 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

Merit-based Incentive Payment System (MIPS)

Final score

82.57 of 100Reported as group

Quality

74.41

Improvement activities

40

Cost

76.03

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: mking@directaddress.net

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.

• The Dermatology Clinic, PLLC

  • Dermatology Physician
  • Gulfport, MS
  • NPI 1720284946
  Medicare reassignment
• Huntsville Hospital Spine and Neuro Center

  • Specialist
  • Huntsville, AL
  • NPI 1407210925
  Medicare reassignment

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1821624370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11295 E TAYLOR RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034197",
            "telephone_number": "228-864-3300",
            "fax_number": "228-864-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11295 E TAYLOR RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034197",
            "telephone_number": "228-864-3300",
            "fax_number": "228-864-3333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6510 Highway 90 Ste C",
            "address_purpose": "LOCATION",
            "city": "Gautier",
            "state": "MS",
            "postal_code": "395535015",
            "country_code": "US",
            "telephone_number": "228-372-8559",
            "fax_number": "228-864-3333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "703 Frontage Dr E",
            "address_purpose": "LOCATION",
            "city": "Wiggins",
            "state": "MS",
            "postal_code": "395778362",
            "country_code": "US",
            "telephone_number": "601-385-8106",
            "fax_number": "228-864-3333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "MARY",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-17",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.1595",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA00646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.thedermclinic.net",
            "affiliation": "N",
            "endpointDescription": "The Dermatology Clinic, PLLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6510 Highway 90 Ste C",
            "city": "Gautier",
            "state": "MS",
            "country_code": "US",
            "postal_code": "395535015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kimila Deflanders LCSW LLC
• Joy M Kiner
• Angelle N King
• Brooklyn King
• Jariva King, LMSW
• Meredith H King, RN
• Rachel Beth King
• Dona Margaret Kioseff, MD
• Adrienne Dianne Hogue Kirby, WHNP
• John H Kirk III, PT

• Physician Assistant in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.