MR. KINGSLEY L MALCOLM (CRNA) – Certified Registered Nurse Anesthetist, NPI 1144550799

MR. KINGSLEY L MALCOLM (CRNA) is a healthcare provider. based in Antioch, Tennessee. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. 511702-1 (NY). The NPI Number for MR. KINGSLEY L MALCOLM (CRNA) is 1144550799

Main info

Male
17 Years Of Experience
Accepts Medicare Assignment
Name
MR. KINGSLEY L MALCOLM (CRNA)
NPI
1144550799
Phone
(615) 424-3918
Address
2824 RADER RIDGE CT
Enumeration Date
4 January 2010
Last Update Date
12 January 2010

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3154931000
Graduation Year
2009 (17 years ago)
PAC ID
1052446556
Group Practice PAC ID
9931010485
Professional Enrollment ID
I20100323000650
Address ID
NY136199703CA1001XSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience46
Completeness75
Years active:16State licenses:1Digital endpointsOther names

2,475 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in NY

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Provider Addresses for MR. KINGSLEY L MALCOLM (CRNA)

  • 2824 RADER RIDGE CT

    ANTIOCH, TN 370135748

    Phone: (615) 424-3918

    Type: Mailing

  • Carthage Area Hospital, 1001, West Street, Carthage, Jefferson County, New York, 13619, United States

    CARTHAGE, NY 136199703

    Phone: (315) 493-1000

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-03-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100323000650ICertified Registered Nurse Anesthetist (Crna)NYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 37013)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9931010485View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YNY
Anesthesiology, Interventional Pain ManagementNY
Nephrology, Internal MedicineMO
-NY
U R O L O G YNY
O B S T E T R I C S/ G Y N E C O L O G YFL
Physician AssistantNY
Nurse PractitionerNY
Otolaryngology, Plastic And Reconstructive SurgeryNY
Nurse PractitionerNY

Reviews

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Frequently asked questions

What is the 10-digit NPI for MR. KINGSLEY L MALCOLM (CRNA)?
MR. KINGSLEY L MALCOLM (CRNA) — NPI 1144550799 — is the standard way to identify this listing.
Is MR. KINGSLEY L MALCOLM (CRNA) listed as active for patients and plans?
The listing shows MR. KINGSLEY L MALCOLM (CRNA) as active in the NPI system.
What is MR. KINGSLEY L MALCOLM (CRNA) best known for clinically?
Directory data describes MR. KINGSLEY L MALCOLM (CRNA) with Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What address line appears for MR. KINGSLEY L MALCOLM (CRNA)?
MR. KINGSLEY L MALCOLM (CRNA)'s geographic hint is Antioch, Tennessee in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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