Kenneth Gibbs, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

M-12671 Issued in ID

Practice address

415 6TH St
Lewiston, ID 83501-2431

Phone

(208) 750-7445

Fax

(208) 750-7395

NPI assigned

Nov 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GEBHBA

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.

• Charles H Croft MD PA

  dba The Really Useful Cardiology Company

  • Interventional Cardiology Physician
  • Melbourne, FL
  • NPI 1285806869

  Cardiovascular Disease

  NPD (past)
• Coastal Cardiology Consultants PA

  dba The Heart & Vascular Institute of Florida

  • Cardiovascular Disease Physician
  • Safety Harbor, FL
  • NPI 1285691477
  NPD (past)
• Omni Healthcare, Inc.

  • Specialist
  • Melbourne, FL
  • NPI 1134191323

  Cardiovascular Disease

  NPD (past)
• Passion Quest, Inc.

  dba Southeast Cardiovascular Imaging

  • Clinic/Center
  • Melbourne, FL
  • NPI 1417087495
  NPD (past)
• Thoracic & Cardiovascular Surgeons LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Atlantis, FL
  • NPI 1649212416
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1174506455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83501",
            "telephone_number": "208-750-7445",
            "fax_number": "208-750-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-750-7445",
            "fax_number": "208-750-7395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 S Highlands Ave",
            "address_purpose": "LOCATION",
            "city": "Sebring",
            "state": "FL",
            "postal_code": "338705416",
            "country_code": "US",
            "telephone_number": "863-471-0165",
            "fax_number": "863-385-7379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBS",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME44229",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "KY",
            "license": "41676",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME44229",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "2016035277",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ID",
            "license": "M-12671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005793300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynnette Leigh Geib, COTA/L
• Gem State Endoscopy
• Genhealth Inc
• Benjamin David Gerthung, LMSW
• Hannah Gibbs, DPT
• Thad Giblette, FNP
• Laura Marie Gifford, PA-C
• Dino Joseph Giolitti, PMHNP
• Susette Marie Elizabeth Gleason
• Sarah J Glenn, LCSW

• Interventional Cardiology Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Interventional Cardiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.