Timothy Devin Kallam, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10336 Issued in NC

Practice address

9915 Park Cedar Dr
Charlotte, NC 28210-8905

Phone

(704) 544-3263

NPI assigned

Aug 18, 2020

Last updated

Aug 18, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Life Health of Greensboro PLLCGroup PAC ID 2860932308, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Active Life Health of Greensboro PLLC

  dba Arthritis Knee Pain Centers

  • Physical Medicine & Rehabilitation Physician
  • Greensboro, NC
  • NPI 1073355566
  Medicare reassignment Care Compare group
• Active Life Health of Cary PLLC

  dba Arthritis Knee Pain Centers

  • Physical Medicine & Rehabilitation Physician
  • Cary, NC
  • NPI 1477395960
  Medicare reassignment NPD
• Active Life Health of Cary PLLC

  dba Arthritis Knee Pain Centers

  • Durable Medical Equipment & Medical Supplies
  • Cary, NC
  • NPI 1053153551
  NPD
• Active Life Health of Greensboro PLLC

  dba Arthritis Knee Pain Centers

  • Durable Medical Equipment & Medical Supplies
  • Greensboro, NC
  • NPI 1245072735
  NPD

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1922610328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4985 FRIENDLY FARMS RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274068213",
            "telephone_number": "336-404-9023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9915 PARK CEDAR DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108905",
            "telephone_number": "704-544-3263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAM",
        "first_name": "TIMOTHY",
        "middle_name": "DEVIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaleidoscope Counseling
• Molly Kaleskas
• Jennifer Ann Kalich, MD
• Katilynn Victoria Kalil, PA
• Marta Maria Kalinski, M.D.
• Rajitha Kallem
• Timothy Carl Kallgren, M.D.
• Mani Jacob Kallupurackal, DO
• Kalons and Glidewell DDS PA
• Johanna Shubert Kalons, DDS

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, 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 18, 2020; 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.