Carissa Marie Kicinski, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06929 Issued in NC

Practice address

4009 Barrett Dr Ste 100
Raleigh, NC 27609-6616

Phone

(919) 848-0132

NPI assigned

Jan 4, 2017

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

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carter Clinic, P aGroup PAC ID 1254429921, 13 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 and National Provider Directory roles.

• Carter Clinic, P a

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1912959834

  NC, Physician Assistant

  Medicare reassignment Care Compare group NPD
• Carter Clinic, P.a.

  • Psychiatry Physician
  • Kinston, NC
  • NPI 1982298261
  NPD (past)
• Carter Clinic, PA

  • Psychiatry Physician
  • Dunn, NC
  • NPI 1215461231
  NPD (past)

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1992240741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9228 YARDLEY TOWN DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275878095",
            "telephone_number": "716-982-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 BARRETT DR STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096616",
            "telephone_number": "919-848-0132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2503 Forest Hills Rd W",
            "address_purpose": "LOCATION",
            "city": "Wilson",
            "state": "NC",
            "postal_code": "278933300",
            "country_code": "US",
            "telephone_number": "252-991-0555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KICINSKI",
        "first_name": "CARISSA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-04",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Khov
• Kian Surgery Center
• Alyssa Marie Kiani, AGNP
• Kiarash Bassiri, OD, PA
• Samuel A Kibrom, PT
• Stephen Downer Kicklighter, M.D.
• Henry Matthews Kidd Jr., DDS
• Kids First Pediatrics of Raleigh, PLLC
• Kids R US Therapy, Inc.
• Kidspeace National Center of North America Inc

• All providers in Raleigh, NC
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.