NPIMap

Individual provider Active NPI

Kenneth E. Rose, M.D.

  • Internal Medicine Physician
  • Muscle Shoals, AL
National Provider Identifier
1215921978
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21078 Issued in AL
Practice address
2410 Avalon Ave
Muscle Shoals, AL 35661-3283
Phone
(256) 386-0808
Fax
(256) 389-8904
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X K8461 TX
Internal Medicine Physician 207R00000X 21078 AL Primary

Addresses

Primary practice location

2410 Avalon Ave
Muscle Shoals, AL 35661-3283

Mailing address

2410 Avalon Ave Ste B
Muscle Shoals, AL 35661-3284
Phone (256) 386-0809

Other identifiers 2

IdentifierTypeStateIssuer
58815OtherALMEDICARE
116304002MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070619000136 AL Practitioner - Internal Medicine 1951333624 Reassigns benefits to 3 organizations
I20240819002281 TX Practitioner - Internal Medicine 1951333624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Texas Southwestern Medical School at Dallas, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians
Dora Roberts Rehabilitation CenterGroup PAC ID 0941285498, 114 clinicians
The West Texas Rehabilitation CenterGroup PAC ID 2860301215, shared by 5 NPIs, 444 clinicians

Practice addresses (Care Compare)

120 E Beauregard Ave
San Angelo, TX 76903-5919
Phone (325) 747-1511

306 W 3Rd St
Big Spring, TX 79720-2429
Phone (432) 267-3806

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3411

Hospital & facility affiliations

  • Shannon Home Health Services Home health agency, San Angelo, TX, CCN 457646
  • Angels Care Home Health of San Angelo Home health agency, San Angelo, TX, CCN 679429
  • Paradigm Homecare Home health agency, San Angelo, TX, CCN 747233
  • Centerwell Home Health Home health agency, Eastland, TX, CCN 457128
  • Country Home Health Home health agency, San Angelo, TX, CCN 679469
  • Concho Hearts Hospice, LLC Hospice, San Angelo, TX, CCN 971627
  • Shannon Medical Center Hospital, San Angelo, TX, CCN 450571
  • Ballinger Memorial Hospital Hospital, Ballinger, TX, CCN 451310
  • Heart of Texas Memorial Hospital Hospital, Brady, TX, CCN 451348
  • Sagecrest Alzheimers Care Center Nursing home, San Angelo, TX, CCN 676091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21078ALMDInternal Medicine Physician
K8461TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
HH Health System - Shoals LLC CurrentSince May 1, 2021 Accepting new patients
Helen Keller Inpatient Physician Services Internal Medicine CurrentSince Feb 7, 2024 Accepting new patients
Shannon Clinic Internal Medicine CurrentSince Aug 1, 2024 Accepting new patients
Avalon Medical Group Internal Medicine CurrentSince Jul 28, 2024 Accepting new patients
RCHP - Florence LLC Internal Medicine CurrentSince Jun 6, 2017 Accepting new patients
Mitchell-Hollingsworth Nursing & Rehab Center Past Accepting new patients
McCulloch County Hospital District Past Accepting new patients

Locations

2410 Avalon Ave
Muscle Shoals, AL 35661
Phone (256) 386-0808

2410 Avalon Ave
Ste B
Muscle Shoals, AL 35661

201 Avalon Ave
Muscle Shoals, AL 35661
Phone (256) 386-1600

1300 S Montgomery Ave
Sheffield, AL 35660
Phone (256) 386-4005

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

Interoperability endpoints

  • Direct secure messaging: krose69089@shannonhealth.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mitchell-Hollingsworth Nursing & Rehab CenterFlorence, AL, CCN 015031 Skilled nursing facility Contracted Managing Employee Jan 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1215921978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 AVALON AVE STE B",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613284",
            "telephone_number": "256-386-0809",
            "fax_number": "256-383-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 AVALON AVE",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613283",
            "telephone_number": "256-386-0808",
            "fax_number": "256-389-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "KENNETH",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K8461",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "21078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "58815",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116304002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muscle Shoals, AL

Sources for this page

Verify at the official NPI Registry.