Kenneth C. Holbrook, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003877 Issued in GA

Practice address

2041 Mesa Valley Way
Suite 100
Austell, GA 30106-6828

Phone

(770) 944-1100

Fax

(770) 944-6469

NPI assigned

Feb 22, 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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Medical College of Georgia School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Resurgens, LLCGroup PAC ID 1153224142, 184 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.holbrook.1@15749.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Resurgens, LLC

  dba Resurgens Orthopaedics

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1386697928
  Medicare reassignment Care Compare group NPD (past)
• Resurgens, LLC

  dba Resurgens Orthopaedics

  • Orthopaedic Surgery Physician
  • Braselton, GA
  • NPI 1033919790
  NPD
• Resurgens, LLC

  dba Resurgens Orthopaedics

  • Orthopaedic Surgery Physician
  • Canton, GA
  • NPI 1053849448
  NPD

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

• Cobb Hospital, Inc

  dba Wellstar Cobb Hospital

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation
• Kennestone Hospital, Inc.

  dba Wellstar Kennestone Hospital

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305849600000",
    "number": "1194790139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 MESA VALLEY WAY",
            "address_2": "SUITE 100",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066828",
            "telephone_number": "770-944-1100",
            "fax_number": "770-944-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 MESA VALLEY WAY",
            "address_2": "SUITE 100",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066828",
            "telephone_number": "770-944-1100",
            "fax_number": "770-944-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLBROOK",
        "first_name": "KENNETH",
        "middle_name": "C.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000150059B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002161B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000150059C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hira Optical LLC (Austell Eye Care)
• Hive Diagnostics LLC
• Natalie Z Hoeting, MD
• Eumeka Lawann Hogans, DMD
• Latrice M Hogue, MD
• Holistic Approach Wellness Center
• Neisha Nicole Holliday
• Allyse Delane Holloman
• Karen Holtzclaw, NP
• Terry Hopper

• Physician Assistant in Austell, GA
• Providers in Austell, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; 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.