NPIMap

Individual provider Active NPI

Randy Kimery, PA

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1902315625
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-10558 Issued in NC
Practice address
5710 Oleander Dr Ste 201
Wilmington, NC 28403-4722
Phone
(833) 365-7246
NPI assigned
Sep 26, 2017
Last updated
Apr 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-10558 NC Primary
Medical Physician Assistant 363AM0700X C06610 MD

Addresses

Primary practice location

5710 Oleander Dr Ste 201
Wilmington, NC 28403-4722

Mailing address

9 Walden Ridge Dr Ste 10
Asheville, NC 28803-8592
Phone (833) 365-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210315002230 NC Practitioner - Physician Assistant 5395005219 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians
Premier Pain Solutions PLLCGroup PAC ID 0749573012, 11 clinicians

Practice addresses (Care Compare)

2010 W Arlington Blvd
Greenville, NC 27834-5779
Phone (252) 847-0601

2430 Emerald PL
Suite 103
Greenville, NC 27834-5743
Phone (252) 752-2140

2800 Ashton Dr
Suite 100
Wilmington, NC 28412-2486
Phone (910) 794-8892

3315 Springbank LN
Suite 202
Charlotte, NC 28226-3198
Phone (240) 566-1629

5710 Oleander Dr
Suite 201
Wilmington, NC 28403-4722
Phone (828) 221-0121

9 Walden Ridge Dr
Suite 10
Asheville, NC 28803-8592
Phone (828) 221-0121

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Mar 1, 2021 Accepting new patients
NMG Health Services LLC CurrentSince May 1, 2021 Accepting new patients
Premier Pain Solutions PLLC CurrentSince Jul 19, 2022 Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince May 1, 2021 Accepting new patients
Advanced Pain Management Specialists, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1091 Hendersonville Rd
Ste 101
Asheville, NC 28803
Phone (828) 221-0121

9 Walden Ridge Dr
Ste 10
Asheville, NC 28803
Phone (828) 221-0121

155 W Mills St
Ste 204
Columbus, NC 28722
Phone (828) 221-0222

48 Hospital Dr
Columbus, NC 28722
Phone (828) 894-0978

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1725 New Hanover Medical Park Dr
Wilmington, NC 28403
Phone (910) 662-9300

2221 S 17th St
Wilmington, NC 28401
Phone (910) 662-7720

5710 Oleander Dr
Ste 201
Wilmington, NC 28403
Phone (828) 221-0121

Interoperability endpoints

  • Direct secure messaging: randy.kimeryjr@952.chartlogic.direct-ci.com

Organizations & group practices 9

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 7

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": "1506384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1902315625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 WALDEN RIDGE DR STE 10",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288038592",
            "telephone_number": "833-365-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5710 OLEANDER DR STE 201",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284034722",
            "telephone_number": "833-365-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMERY",
        "first_name": "RANDY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-26",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10558",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C06610",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.