Keva Doreen Southwell, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10017 Issued in NC

Practice address

430 Waterstone Dr
Hillsborough, NC 27278-9078

Phone

(984) 215-2010

Fax

(984) 215-2497

NPI assigned

May 13, 2015

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 OR, NC2 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

Oregon Health Sciences University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of North Carolina at Chapel HillGroup PAC ID 0648181156, 2,028 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Unc Hospitals Hospital, Chapel Hill, NC, CCN 340061

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.

• University of North Carolina at Chapel Hill

  • Anesthesiology Physician
  • Chapel Hill, NC
  • NPI 1780669200
  Medicare reassignment Care Compare group NPD
• Recovery Works NW LLC

  • Multi-Specialty Clinic/Center
  • Tigard, OR
  • NPI 1083010094
  Medicare reassignment
• University of North Carolina at Chapel Hill

  • Family Medicine Physician
  • Raleigh, NC
  • NPI 1972912285
  NPD
• Recovery Works NW LLC

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1871264416
  NPD (past)

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

• University of North Carolina Hospitals at Chapel Hill

  • General Acute Care Hospital
  • Chapel Hill, NC
  • NPI 1932208576
  Care Compare affiliation

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1891173571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 WATERSTONE DR",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "272789078",
            "telephone_number": "984-215-2010",
            "fax_number": "984-215-2497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 WATERSTONE DR",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "272789078",
            "telephone_number": "984-215-2010",
            "fax_number": "984-215-2497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Manning Dr",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275144220",
            "country_code": "US",
            "telephone_number": "919-966-7890",
            "fax_number": "919-966-9533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "KEVA",
        "middle_name": "DOREEN",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-13",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksouthwell640089@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "430 Waterstone Dr",
            "city": "Hillsborough",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272789078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark Jacob Solomon, PH.D.
• Theresa P Solomon
• William Alan Somers, M.D.
• Christopher Soto, LCMHCA
• Southeast Diabetic Supply Inc
• Anna Fitzpatrick Sparr, PHYSICAL THERAPIST
• Simon H Spire, LCSWA
• Rivkah Zelda Krevsky Stack
• Toya Danielle Staley, CPSS
• Maddox Gray Stampley, DPT

• Physician Assistant in Hillsborough, NC
• Providers in Hillsborough, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.