Kenneth L Fan, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

MD045855 Issued in DC

Practice address

3800 Reservoir Rd NW
Department of Plastic Surgery
Washington, DC 20007

Phone

(202) 444-1233

NPI assigned

Apr 2, 2012

Sex

Male

Sole proprietor

Yes

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 DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Plastic and Reconstructive Surgery

Education

University of Miami, LM Miller School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medstar Georgetown University Hospital Hospital, Washington, DC, CCN 090004

Merit-based Incentive Payment System (MIPS)

Final score

82.34 of 100Reported as group

Quality

67.9

Promoting interoperability

100

Improvement activities

40

Cost

69.47

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment Care Compare group NPD
• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• Medstar - Georgetown Medical Center, Inc.

  • General Acute Care Hospital
  • Washington, DC
  • NPI 1427145176

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1144586355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 RESERVOIR RD NW",
            "address_2": "DEPARTMENT OF PLASTIC SURGERY",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200072113",
            "telephone_number": "202-444-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 RESERVOIR RD NW",
            "address_2": "DEPARTMENT OF PLASTIC SURGERY",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20007",
            "telephone_number": "202-444-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "KENNETH",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-02",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "DC",
            "license": "MD045855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mercy Adeyela Famogun
• Gerard Famongbwa
• Feyisola Omotola Famoriyo
• Priscilla Famous
• Oluwagbenga A Famuyide
• Shu Fan, ACUPUNCTURIST
• Joachim Michael Fanale, MD
• Nasser Cedric Fanche
• Stella Fanda, HHA
• Marcelle A Wandji Fandio Mbami, LPN

• Plastic Surgery Physician in Washington, DC
• Providers in Washington, DC by specialty
• Plastic Surgery Physician in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; 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.