Individual provider Active NPI

Kylie Ann Sabol

  • Physician Assistant
  • Iron Mountain, MI
National Provider Identifier
1942055165
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1711 S Stephenson Ave
Iron Mountain, MI 49801-3639
Phone
(906) 774-1313
NPI assigned
Apr 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1711 S Stephenson Ave
Iron Mountain, MI 49801-3639

Mailing address

1318 N Brummitt Rd
Chesterton, IN 46304-9520
Phone (219) 928-3361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WA2 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

Enrollment IDStateProvider typePAC IDDetails
I20240723001102 MI Practitioner - Physician Assistant 7113463472 Reassigns benefits to 1 organization
I20250926002327 WA Practitioner - Physician Assistant 7113463472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians

Practice addresses (Care Compare)

2811 Tieton Dr
Yakima, WA 98902-3761
Phone (509) 575-8000

311 S 72ND Ave
Yakima, WA 98908-1661
Phone (509) 972-1818

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dickinson County Healthcare System Physician Assistant CurrentSince Jul 22, 2024 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Sep 4, 2025 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Sep 4, 2025 Accepting new patients

Locations

1711 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-0550

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

311 S 72nd Ave
Yakima, WA 98908
Phone (509) 927-1818

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1942055165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 N BRUMMITT RD",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049520",
            "telephone_number": "219-928-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S STEPHENSON AVE",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013639",
            "telephone_number": "906-774-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SABOL",
        "first_name": "KYLIE",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iron Mountain, MI

Sources for this page

Verify at the official NPI Registry.