Kenny Gaston

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

12158 Central Ave
Mitchellville, MD 20721-1932

Phone

(301) 430-2750

NPI assigned

Oct 19, 2018

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, MD2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sports Pro Physical Therapy EastGroup PAC ID 1951770411, 2 clinicians

Sports Pro Physical Therapy LLCGroup PAC ID 4688748106, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Sports Pro Physical Therapy East

  • Physical Therapist
  • Annapolis, MD
  • NPI 1346998978
  Medicare reassignment Care Compare group NPD
• Sports Pro Physical Therapy LLC

  • Physical Therapist
  • Upper Marlboro, MD
  • NPI 1285611608

  DC

  Medicare reassignment Care Compare group NPD
• Sports Pro Physical Therapy LLC.

  • Physical Therapist
  • Glenn Dale, MD
  • NPI 1932576378
  NPD (past)

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

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1205302973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 TWIG TER",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209057038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12158 CENTRAL AVE",
            "city": "MITCHELLVILLE",
            "state": "MD",
            "postal_code": "207211932",
            "telephone_number": "301-430-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GASTON",
        "first_name": "KENNY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-19",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ajanae Fowlkes-Carter
• Olurotimi Samuel Fowowe
• Alexia I Georges
• Audra N Gillis, MSW
• Danya Gordon, LGPC
• Carly Cook Granata, PA-C
• Ariane Z Grant, PT, DPT

• Student in an Organized Health Care Education/Training Program in Mitchellville, MD
• Providers in Mitchellville, MD by specialty
• Student in an Organized Health Care Education/Training Program in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.