Individual provider Active NPI

Kimberly J Martin, PA-C

  • Medical Physician Assistant
  • Wilmington, NC
National Provider Identifier
1861563728
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
102654 Issued in NC
Practice address
6419 Carolina Beach Road
Suite a
Wilmington, NC 28412-2759
Phone
(910) 790-3660
NPI assigned
Nov 13, 2006
Last updated
Jun 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 102654 NC Primary

Addresses

Primary practice location

6419 Carolina Beach Road
Suite a
Wilmington, NC 28412-2759

Mailing address

6419 Carolina Beach Road
Suite a
Wilmington, NC 28412-2759
Phone (910) 790-3660

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
I20040331000988 NC Practitioner - Physician Assistant 8527050574 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RDMG Associates PAGroup PAC ID 9537442215, 27 clinicians

Practice addresses (Care Compare)

6419 Carolina Beach Rd
Suite a
Wilmington, NC 28412-3672
Phone (910) 790-3660

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
102654NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
RDMG Associates, PA Physician Assistant Current Accepting new patients
RDMG Associates PA Physician Assistant CurrentSince May 1, 2017 Accepting new patients
RDMG Associates PA Physician Assistant Past Accepting new patients
Wilmington Health PLLC Past Accepting new patients

Locations

10620 Park Rd
Ste 128
Charlotte, NC 28210
Phone (704) 542-6111

6419 Carolina Beach Rd
Ste A
Wilmington, NC 28412
Phone (910) 790-3660

Interoperability endpoints

  • Direct secure messaging: kimberlymartin@mfmpc.allscriptsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1861563728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6419 CAROLINA BEACH ROAD",
            "address_2": "SUITE A",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122759",
            "telephone_number": "910-790-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6419 CAROLINA BEACH ROAD",
            "address_2": "SUITE A",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122759",
            "telephone_number": "910-790-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "102654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.