G. Edward Kienzle, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD007413E Issued in PA

Practice address

17 Industrial Blvd
Suite 204
Paoli, PA 19301-1607

Phone

(610) 647-1484

Fax

(610) 647-7068

NPI assigned

Mar 7, 2006

Sex

Male

Sole proprietor

No

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 PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17038/brand/1/csg/1/fhir/r4

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.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643
  NPD (past)
• Pediatric Associates of Paoli, PC

  • Pediatrics Physician
  • Paoli, PA
  • NPI 1083683742
  NPD (past)

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1174590244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 INDUSTRIAL BLVD",
            "address_2": "SUITE 204",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011607",
            "telephone_number": "610-647-1484",
            "fax_number": "610-647-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 INDUSTRIAL BLVD",
            "address_2": "SUITE 204",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011607",
            "telephone_number": "610-647-1484",
            "fax_number": "610-647-7068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIENZLE",
        "first_name": "G. EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD007413E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louise Kennedy, MS
• Debra Lynn Kenney, OD
• Rachel Lauren Kerr, PA-C
• Jennifer Kiblinger
• Linda Kiefer, LCSW
• Rand E Kienzle, MD
• Michelle Kimmerly
• Abigail Zisk Kindler, PHD
• Sandra E. Klos, PH.D.
• Cynthia Knapp, MA

• Pediatrics Physician in Paoli, PA
• Providers in Paoli, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.