Active NPI
Kenneth S Wayne, MD
- Internal Medicine Physician
- Ottumwa, IA
National Provider Identifier
1174500151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 32349
- Practice address
- 1005 Pennsylvania Ave
Suite 104
Ottumwa, IA 52501-6413 - Phone
- (641) 682-4594
- Fax
- (641) 682-2123
- NPI assigned
- Dec 29, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 32349 | IA | Primary |
| Pulmonary Disease Physician | 207RP1001X | 32349 | IA |
Addresses
Primary practice location
1005 Pennsylvania Ave
Suite 104
Ottumwa, IA 52501-6413
Mailing address
1005 Pennsylvania Ave
Suite 104
Ottumwa, IA 52501-6413
Phone (641) 682-4594
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2169417 | Medicaid | IA | |
| 1174500151 | Medicaid | IA | |
| 0169417 | Medicaid | IA | |
| 110166527 | Other | IA | RR MEDICARE |
| 1169417 | Medicaid | IA |
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 |
|---|---|---|---|
| 32349 | IA | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337212800000",
"number": "1174500151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 PENNSYLVANIA AVE",
"address_2": "SUITE 104",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525016413",
"telephone_number": "641-682-4594",
"fax_number": "641-682-2123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 PENNSYLVANIA AVE",
"address_2": "SUITE 104",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525016413",
"telephone_number": "641-682-4594",
"fax_number": "641-682-2123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAYNE",
"first_name": "KENNETH",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-29",
"last_updated": "2012-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IA",
"license": "32349",
"primary": true
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "IA",
"license": "32349",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2169417",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174500151",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0169417",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "110166527",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1169417",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.