Kenneth K Greenwood, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

29687 Issued in TN

Practice address

951 Pondella Rd
Coastal Behavioral Healthcare
North Fort Myers, FL 33903-3532

Phone

(239) 656-3461

Fax

(239) 656-3462

NPI assigned

Sep 12, 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 17

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Psychiatry

Education

East Tennessee State University Quillen College of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Centerstone of Florida IncGroup PAC ID 2668468596, 35 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Centerstone of Florida, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bradenton, FL
  • NPI 1144251638
  Medicare reassignment Care Compare group NPD
• Cherokee Health Systems

  • Federally Qualified Health Center (FQHC)
  • Talbott, TN
  • NPI 1134128820

  Psychiatry

  NPD (past)
• Frontier Health

  • Rehabilitation Clinic/Center
  • Johnson City, TN
  • NPI 1730245010
  NPD (past)
• Frontier Health

  • Adult Mental Health Clinic/Center
  • Bristol, TN
  • NPI 1821154352
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1275637951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 PONDELLA RD",
            "address_2": "COASTAL BEHAVIORAL HEALTHCARE",
            "city": "NORTH FORT MYERS",
            "state": "FL",
            "postal_code": "339033532",
            "telephone_number": "239-656-3461",
            "fax_number": "239-656-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 PONDELLA RD",
            "address_2": "COASTAL BEHAVIORAL HEALTHCARE",
            "city": "NORTH FORT MYERS",
            "state": "FL",
            "postal_code": "339033532",
            "telephone_number": "239-656-3461",
            "fax_number": "239-656-3462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWOOD",
        "first_name": "KENNETH",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "29687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MCC",
            "identifier": "1013306",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100725315 EAST",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PINNACLE",
            "identifier": "3085173",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH NETW",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHLANDS WELLMONT",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INITIAL GROUP",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARITEN PHP POS",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH JOHN DEERE",
            "identifier": "620582605W5",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN SUMMIT",
            "identifier": "3085173",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARITEN PHP PPO",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEECH STREET",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPHEALTH",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN NAVIGATOR",
            "identifier": "3085173",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS GROUP",
            "identifier": "334969",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARITEN PHP HMO",
            "identifier": "620582605",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH HEALTHPLAN",
            "identifier": "107340",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "620582605",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kia Ayana Glimps-Smith
• Susan Rachel Goins, SUPPORT COORDINATOR
• Mary-Ann Gonzalez
• Graceful Homes LLC
• Lessie Greene
• Raven Grimm
• Keylin Natalia Gutierrez Rodriguez
• Guy Ditommaso DC PA
• Amelia Hagman
• Melinda Ann Hall, LMHC

• Psychiatry Physician in North Fort Myers, FL
• Providers in North Fort Myers, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; 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.