Kenneth D Root, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601003447 Issued in MI

Practice address

1179 E Paris Ave SE Ste 150
Grand Rapids, MI 49546-8373

Phone

(616) 455-9450

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Jean Talsma DO PLLCGroup PAC ID 7911477633, 4 clinicians

John N Campbell MD PCGroup PAC ID 9335155316, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kroot51209@epic00.corewelldirect.org

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.

• Jean Talsma DO PLLC

  • Addiction Medicine (Internal Medicine) Physician
  • Grand Rapids, MI
  • NPI 1538016241
  Medicare reassignment Care Compare group
• John N Campbell MD PC

  • Addiction Medicine (Internal Medicine) Physician
  • Kentwood, MI
  • NPI 1598853608
  Medicare reassignment Care Compare group
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment NPD
• John N Campbell MD PC

  • Rural Health Clinic/Center
  • Big Rapids, MI
  • NPI 1336737964
  NPD
• Spectrum Health Primary Care Partners

  • Occupational Medicine Clinic/Center
  • Grand Rapids, MI
  • NPI 1194141341
  NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD
• Memorial Hospital

  • Anesthesiology Physician
  • Owosso, MI
  • NPI 1659527737
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1053353946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 E PARIS AVE SE STE 150",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468373",
            "telephone_number": "616-455-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 E PARIS AVE SE STE 150",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468373",
            "telephone_number": "616-455-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOT",
        "first_name": "KENNETH",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Root and Bloom Wellness LLC
• Root Canal Specialists North, PLLC
• Lindsey M Root-Luna, PH.D.
• Andrea Elizabeth Root
• Katherine Root, COTA
• Mariah Elizabeth Ann Root, LMSW, LCSW
• Corinna Marie Rop
• Esther Jelagat Rop
• Daniel Roper, MD
• Laura Ropp, CTRS, QIDP

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; 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.