Kyle Vaughn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110007161 Issued in VA

Practice address

814 Kempsville Rd Ste 102
Norfolk, VA 23502-4001

Phone

(757) 623-0005

Fax

(757) 389-5412

NPI assigned

Feb 20, 2017

Sex

Male

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 NC, VA2 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

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tidewater Kidney Specialists IncGroup PAC ID 6507852662, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Leigh Hospital Hospital, Norfolk, VA, CCN 490046

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kylevaughn@tks.allscriptsdirect.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.

• Tidewater Kidney Specialists, Inc.

  • Nephrology Physician
  • Virginia Beach, VA
  • NPI 1780624627
  Medicare reassignment Care Compare group NPD
• Eastern Nephrology Associates PLLC

  • Nephrology Physician
  • Greenville, NC
  • NPI 1417083783
  Medicare reassignment

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

• Sentara Hospitals

  • General Acute Care Hospital
  • Norfolk, VA
  • NPI 1811957681
  Care Compare affiliation

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1841739141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623666",
            "telephone_number": "757-623-0005",
            "fax_number": "757-548-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 KEMPSVILLE RD STE 102",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024001",
            "telephone_number": "757-623-0005",
            "fax_number": "757-389-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "KYLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-07079",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110007161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.tksva.com/",
            "affiliation": "N",
            "address_1": "814 Kempsville Rd Ste 102",
            "city": "Norfolk",
            "state": "VA",
            "country_code": "US",
            "postal_code": "235024001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rishik Vashisht, M.D.
• Jacqueline Mary Vaughan, CCC-SLP
• Kimberly Vaughan
• Tierra Marie Vaughan
• Krystal Vaughn
• Shekinah Joy Vaughn, MD
• Wallisa Tejarnette Vaughn, M.D.
• Ana H. Vazquez, M.D.
• VCDS
• VCDS Virginia Consumer Directed Services

• Medical Physician Assistant in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.