NPIMap

Individual provider Active NPI

Kenneth Douglas Shank, DO

  • Family Medicine Physician
  • Albemarle, NC
National Provider Identifier
1083695159
Registry record updated Feb 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
109181 Issued in NC
Practice address
815 N 3Rd St
Albemarle, NC 28001-3403
Phone
(704) 983-3508
Fax
(704) 983-3509
NPI assigned
Nov 7, 2005
Last updated
Feb 4, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 109181 NC Primary

Addresses

Primary practice location

815 N 3Rd St
Albemarle, NC 28001-3403

Mailing address

815 N 3Rd St
Albemarle, NC 28001-3403
Phone (704) 983-3508

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080122000813 NC Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 1658452107 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
Philadelphia College of Osteopathic Medicine, 1999
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Comprehab, IncGroup PAC ID 2769653757, 376 clinicians
Med First Immediate Care and Family Practice PAGroup PAC ID 0446332720, 94 clinicians

Practice addresses (Care Compare)

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

4002 Elton Way
Suite 105
Greensboro, NC 27406-8973
Phone (336) 860-0981

609 Richlands Hwy 6
Jacksonville, NC 28540-3606
Phone (910) 455-7888

929 N 2ND St
Suite 201
Albemarle, NC 28001-3365
Phone (704) 983-3508

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
109181NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Med First Immediate Care & Family Practice, PA Family Medicine CurrentSince Sep 1, 2022 Accepting new patients
Stanly Medical Services, Inc. Family Medicine Past Accepting new patients

Locations

929 N 2nd St
Ste 201
Albemarle, NC 28001
Phone (704) 983-2700

609 Richlands Hwy
Ste 6
Jacksonville, NC 28540
Phone (910) 455-7888

Interoperability endpoints

  • Direct secure messaging: kenneth.shank.1@1905.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202083200000",
    "number": "1083695159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N 3RD ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280013403",
            "telephone_number": "704-983-3508",
            "fax_number": "704-983-3509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N 3RD ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280013403",
            "telephone_number": "704-983-3508",
            "fax_number": "704-983-3509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANK",
        "first_name": "KENNETH",
        "middle_name": "DOUGLAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2008-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "109181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albemarle, NC

Sources for this page

Verify at the official NPI Registry.