Individual provider Active NPI

Kenneth Henry Hilborne Jr., NP

  • Nurse Practitioner
  • Canton, NY
National Provider Identifier
1346218773
Registry record updated Dec 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F330919 Issued in NY
Practice address
4 Commerce Lane
Canton, NY 13617
Phone
(315) 386-8191
Fax
(315) 386-1410
NPI assigned
Mar 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F330919 NY Primary

Addresses

Primary practice location

4 Commerce Lane
Canton, NY 13617

Mailing address

605 Elizabeth St
Ogdensburg, NY 13669
Phone (315) 393-4728

Other identifiers 2

IdentifierTypeStateIssuer
01995615MedicaidNY
161568985LAIOtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20110210000237 NY Practitioner - Nurse Practitioner 6608056528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4 Commerce LN
Canton, NY 13617-3739
Phone (315) 386-8191

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F330919NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
United Cerebral Palsy Association of the North Country, Inc. CurrentSince Jan 5, 2000 Accepting new patients

Locations

4 Commerce Ln
Canton, NY 13617
Phone (315) 386-1156

380 County Route 51
Malone, NY 12953
Phone (518) 483-0109

Organizations & group practices 1

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 3

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": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260403200000",
    "number": "1346218773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 ELIZABETH ST",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "13669",
            "telephone_number": "315-393-4728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 COMMERCE LANE",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "13617",
            "telephone_number": "315-386-8191",
            "fax_number": "315-386-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILBORNE",
        "first_name": "KENNETH",
        "middle_name": "HENRY",
        "name_suffix": "Jr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2009-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F330919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01995615",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "161568985LAI",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, NY

Sources for this page

Verify at the official NPI Registry.