William Kenworthey, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

51396 Issued in CA

Practice address

905 Maple Street
3Rd Floor, Neurosurgery Clinic, Office #3095
Redwood City, CA 94063

Phone

(650) 299-2290

Fax

(650) 299-2677

NPI assigned

Mar 21, 2014

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group
• Cal Med Physicians and Surgeons, Inc.

  • Surgery Physician
  • Colton, CA
  • NPI 1316054737
  Medicare reassignment

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

{
    "created_epoch": "1395360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1083031504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 MAPLE STREET",
            "address_2": "3RD FLOOR, NEUROSURGERY CLINIC, OFFICE #3095",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94063",
            "telephone_number": "650-299-2290",
            "fax_number": "650-299-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 MAPLE STREET",
            "address_2": "3RD FLOOR, NEUROSURGERY CLINIC, OFFICE #3095",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94063",
            "telephone_number": "650-299-2290",
            "fax_number": "650-299-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENWORTHEY",
        "first_name": "WILLIAM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-21",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "51396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1150 Veterans Blvd",
            "city": "Redwood City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940632037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donald J Kemp Jr., PA-C
• Bridget Kenevan, LMFT
• Gannon Daniel Kennedy, M.D.
• Neeve Kennedy, DPT
• Kenneth a Holman DDS Inc
• Charlotte Kernan Moore
• Timothy Kershenstine
• Hearmon Semere Kesete
• Jaycie Kessell
• Karen Marie Ketner, NP

• Surgical Physician Assistant in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; 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.