NPIMap

Individual provider Active NPI

Kenneth B Gallmore II, D.O.

  • Internal Medicine Physician
  • Farmington Hills, MI
National Provider Identifier
1124004817
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101013600 Issued in MI
Practice address
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone
(947) 521-8000
NPI assigned
Dec 15, 2005
Last updated
Feb 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101013600 MI Primary

Addresses

Primary practice location

28050 Grand River Ave
Farmington Hills, MI 48336-5919

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other practice location 1

6149 N Wayne Rd
Westland, MI 48185-7128
Phone (734) 728-4141

Other identifiers 3

IdentifierTypeStateIssuer
1124004817MedicaidMI
700F314390OtherMIBLUE SHIELD
700H219150OtherMIBLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgallmore96836@direct.beaumont.educ Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040909001312 MI Practitioner - Internal Medicine 9537135595 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaumont Medical Group Hospital Based ServicesGroup PAC ID 3072875889, 575 clinicians

Practice addresses (Care Compare)

10000 Telegraph Rd
Taylor, MI 48180-3330
Phone (313) 295-5360

28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (947) 521-8196

39000 7 Mile Rd
Livonia, MI 48152-1006
Phone (947) 523-4310

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-1187

44201 Dequindre Rd Ec
Beaumont Emergency Services TR
Troy, MI 48085-1117
Phone (248) 964-5111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.64 of 100Reported as group
Quality
85.06
Promoting interoperability
100
Improvement activities
40
Cost
77.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101013600MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group Hospital -Based Services CurrentSince Feb 18, 2018 Accepting new patients
Inpatient Consultants of Michigan PC Internal Medicine CurrentSince Jun 13, 2017 Accepting new patients
Ardan, Inc. Past Accepting new patients
Botsford General Hospital Past Accepting new patients
Henry Ford Physician Partners Past Accepting new patients
Motor City Internists Internal Medicine Past Accepting new patients

Locations

22600 W Main St
Armada, MI 48005
Phone (734) 508-4569

1014 E Grand River Ave
Brighton, MI 48116
Phone (810) 220-5222

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

21450 Archwood Cir
Farmington Hills, MI 48336
Phone (248) 426-6903

28050 Grand River Ave
Farmington Hills, MI 48336
Phone (248) 471-8000

12200 Broadbent Rd
Lansing, MI 48917
Phone (517) 731-6200

36123 Schoolcraft Rd
Livonia, MI 48150
Phone (734) 793-6140

555 Highland Ave
Milford, MI 48381
Phone (248) 684-1564

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

11012 E 13 Mile Rd
Warren, MI 48093
Phone (586) 573-8890

38410 Cherry Hill Rd
Westland, MI 48185
Phone (734) 326-1200

625 36th St SW
Wyoming, MI 49509
Phone (517) 481-3715

Interoperability endpoints

  • Direct secure messaging: kgallmore1234409@epic00.shdirect.org
  • Direct secure messaging: kgallmore409318@direct.hfhs.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hartford Nursing & Rehabilitation CenterDetroit, MI, CCN 235177 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Jan 1, 2025
Corsocare HospiceMilford, MI, CCN 231649 Hospice Contracted Managing Employee Jun 15, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1124004817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28050 GRAND RIVER AVE",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483365919",
            "telephone_number": "947-521-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6149 N Wayne Rd",
            "address_purpose": "LOCATION",
            "city": "Westland",
            "state": "MI",
            "postal_code": "481857128",
            "country_code": "US",
            "telephone_number": "734-728-4141",
            "fax_number": "734-728-2626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLMORE",
        "first_name": "KENNETH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101013600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124004817",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "700F314390",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "700H219150",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgallmore96836@direct.beaumont.educ",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "28050 Grand River Ave",
            "city": "Farmington Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483365919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington Hills, MI

Sources for this page

Verify at the official NPI Registry.