Active NPI
Kenneth J Boyd, M.D.
- Colon & Rectal Surgery Physician
- Media, PA
National Provider Identifier
1144226606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Colon & Rectal Surgery Physician
- License
- MD036083E
- Practice address
- 1088 W Baltimore Pike
Ste 2101
Media, PA 19063-5136 - Phone
- (610) 565-3435
- Fax
- (610) 566-1387
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Colon & Rectal Surgery Physician | 208C00000X | MD036083E | PA | Primary |
Addresses
Primary practice location
1088 W Baltimore Pike
Ste 2101
Media, PA 19063-5136
Mailing address
1088 W Baltimore Pike
Ste 2101
Media, PA 19063-5136
Phone (610) 565-3435
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0011209700002 | Medicaid | PA | |
| 32129B | Other | PA | KEYSTONE MERCY HEALTH PLA |
| 280000253 | Other | PA | MEDICARE RAILROAD |
| 0031097000 | Other | PA | INDEPENDENCE BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD036083E | PA | MD | Colon & Rectal Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Main Line Healthcare | Colon & Rectal Surgery | Past | Accepting new patients |
Interoperability endpoints
- kennethj.boyd@colonandrectalsurgeryltd.chartmakerdirect.com
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Newtown Square, PA
- NPI 1922077643
Colon & Rectal Surgery
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292284800000",
"number": "1144226606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1088 W BALTIMORE PIKE",
"address_2": "STE 2101",
"city": "MEDIA",
"state": "PA",
"postal_code": "190635136",
"telephone_number": "610-565-3435",
"fax_number": "610-566-1387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1088 W BALTIMORE PIKE",
"address_2": "STE 2101",
"city": "MEDIA",
"state": "PA",
"postal_code": "190635136",
"telephone_number": "610-565-3435",
"fax_number": "610-566-1387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYD",
"first_name": "KENNETH",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2010-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "208C00000X",
"taxonomy_group": "",
"desc": "Colon & Rectal Surgery",
"state": "PA",
"license": "MD036083E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0011209700002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY HEALTH PLA",
"identifier": "32129B",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "280000253",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "0031097000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Media, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.