Individual provider Active NPI

Kenneth Vernon Slack, MD

  • Emergency Medicine Physician
  • Orlando, FL
National Provider Identifier
1013169879
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME119973 Issued in FL
Practice address
7727 Lake Underhill Rd
Orlando, FL 32822-8224
Phone
(407) 303-6413
NPI assigned
Oct 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X TRN18079 FL
Surgery Physician 208600000X 24792 NE
Emergency Medicine Physician 207P00000X ME119973 FL Primary

Addresses

Primary practice location

7727 Lake Underhill Rd
Orlando, FL 32822-8224

Mailing address

7727 Lake Underhill Rd
Orlando, FL 32822-8224
Phone (407) 303-6413

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150909001610 FL Practitioner - Emergency Medicine 0840428850 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
24792NEMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Emergency Physicians Kang and Associates MD LLC Emergency Medicine CurrentSince Aug 1, 2015 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Mar 13, 2024 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Mar 13, 2024 Accepting new patients
Emergency Physicians of Central Florida LLP Emergency Medicine CurrentSince Jun 1, 2018 Accepting new patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Augustine Emergency Physicians LLC Emergency Medicine Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

601 E Altamonte Dr
Altamonte Springs, FL 32701
Phone (407) 303-2200

1900 Don Wickham Dr
Clermont, FL 34711
Phone (352) 536-8761

555 W State Road 434
Longwood, FL 32750
Phone (407) 767-1200

7800 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 267-1603

7334 Navarre Pkwy
Navarre, FL 32566
Phone (850) 416-2337

7727 Lk Under Hl
Orlando, FL 32822
Phone (407) 303-6413

1414 S Orange Ave
#112
Orlando, FL 32806
Phone (407) 767-1200

5151 N 9th Ave
Pensacola, FL 32504
Phone (850) 202-4700

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

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.

NPI Registry JSON

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

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1013169879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7727 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228224",
            "telephone_number": "407-303-6413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228224",
            "telephone_number": "407-303-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "KENNETH",
        "middle_name": "VERNON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-10",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "TRN18079",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NE",
            "license": "24792",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME119973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.