NPIMap

Individual provider Active NPI

Kacie Amanda Davis, PA

  • Medical Physician Assistant
  • Dothan, AL
National Provider Identifier
1972970747
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1801 Issued in AL
Practice address
210 Westside Dr
Dothan, AL 36303-1928
Phone
(334) 793-5074
NPI assigned
Aug 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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 1801 AL Primary

Addresses

Primary practice location

210 Westside Dr
Dothan, AL 36303-1928

Mailing address

PO Box 6599
Dothan, AL 36302-6599

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kacie.davis.1@3326.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20151005001588 AL Practitioner - Physician Assistant 3577871953 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Alabama College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wiregrass Clinic LLCGroup PAC ID 2860662491, 69 clinicians

Practice addresses (Care Compare)

210 Westside Dr
Dothan, AL 36303-1928
Phone (334) 793-5074

4300 W Main St
Dothan, AL 36305-1058

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Dothan, AL, CCN 017164
  • Amedisys Home Health Home health agency, Dothan, AL, CCN 017159
  • Centerwell Home Health Home health agency, Geneva, AL, CCN 017048
  • Enhabit Home Health Home health agency, Dothan, AL, CCN 017053
  • Southeast Alabama Homecare Home health agency, Dothan, AL, CCN 017024
  • Flowers Hospital Hospital, Dothan, AL, CCN 010055
  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001
  • Medical Center Enterprise Hospital, Enterprise, AL, CCN 010049

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1801ALMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Houston County Healthcare Authority CurrentSince Aug 26, 2015 Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Pathology Laboratory Associates Current Accepting new patients
Houston County Healthcare Authority Current Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

Interoperability endpoints

  • Direct secure messaging: kacie.davis.1@3326.direct.athenahealth.com

Organizations & group practices 6

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 8

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": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1972970747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6599",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363026599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KACIE",
        "middle_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-28",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "1801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kacie.davis.1@3326.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Athena EMR",
            "address_1": "210 Westside Dr",
            "city": "Dothan",
            "state": "AL",
            "country_code": "US",
            "postal_code": "363031928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.