Kenny Iman, P.A.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

C0003072 Issued in MD

Practice address

111 Davis St
Salisbury, MD 21804-5032

Phone

(410) 749-4154

NPI assigned

Nov 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MD

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

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ydiprmc, LLCGroup PAC ID 3173897402, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidalhealth Peninsula Regional, Inc Hospital, Salisbury, MD, CCN 210019

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Ydiprmc LLC

  • Urgent Care Clinic/Center
  • Salisbury, MD
  • NPI 1447783899
  Medicare reassignment Care Compare group
• Access Primary Care LLC

  • Primary Care Clinic/Center
  • Ocean City, MD
  • NPI 1033550496
  Medicare reassignment
• Acute Injury and Illness Centers LLC

  • Urgent Care Clinic/Center
  • Ocean City, MD
  • NPI 1548330343
  Medicare reassignment

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

• Tidalhealth Peninsula Regional, Inc.

  • General Acute Care Hospital
  • Salisbury, MD
  • NPI 1780689463
  Care Compare affiliation

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1295801173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 OAKLAND SCHOOL RD",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218042715",
            "telephone_number": "410-726-1576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DAVIS ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218045032",
            "telephone_number": "410-749-4154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMAN",
        "first_name": "KENNY",
        "name_prefix": "Mr.",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "C0003072",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "DE",
            "license": "C50000664",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "P.A. LICENSE",
            "identifier": "C0003072",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION P.A.C.",
            "identifier": "1066952",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE CONTROLLED SUBSTA",
            "identifier": "PA60330",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deena Ann Hynson
• Geri Renae Iames, NP
• Ifcs of Maryland, Inc. a/K/a Institute for Family Centered Services, I
• Peace Ige, MD
• Titilayo Ilori
• Kristen Marie Iman, D.C
• April Imparato, CRNP
• Imperial Healthcare Services LLC
• Imperial Healthcare Services LLC
• Imperial Healthcare Services LLC

• Specialist in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Specialist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.