Active NPI
Kenneth A Buddendorf III, M.D.
- Anesthesiology Physician
- Tavares, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- ME86582
- Practice address
- 1000 Waterman Way
Tavares, FL 32778-5266 - Phone
- (352) 253-3333
- Fax
- (352) 589-3487
- NPI assigned
- Aug 28, 2006
- Last updated
- Dec 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | ME86582 | FL | Primary |
Addresses
Primary practice location
1000 Waterman Way
Tavares, FL 32778-5266
Mailing address
PO Box 3130
Ocala, FL 34478-3130
Phone (352) 867-8311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 78596 | Other | FL | BC BS |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- Louisiana State University School of Medicine in New Orleans, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1000 Waterman Way
Tavares, FL 32778-5266
Phone (352) 253-3333
601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-5600
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.8 of 100
- Quality
- 99.47
- Improvement activities
- 40
- Cost
- 83.62
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16437 | AL | MD | Pharmacist |
| ME86582 | FL | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| US Anesthesia Partners of Florida Inc. | Anesthesiology | Current | Accepting new patients |
| Anesthesia Services PC | Anesthesiology | Past | Accepting new patients |
| Tri-County Anesthesia Volusia | Anesthesiology | Past | Accepting new patients |
Locations
851 Trafalgar Ct
Ste 200E
Maitland, FL 32751
Phone (321) 422-7155
601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996
1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba JLR Anesthesia Assoc
- Anesthesiology Physician
- Maitland, FL
- NPI 1518910520
-
- Certified Registered Nurse Anesthetist
- Sanford, FL
- NPI 1760420111
Anesthesiology
-
- Anesthesiology Physician
- Mobile, AL
- NPI 1649265810
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba AdventHealth Waterman
- General Acute Care Hospital
- Tavares, FL
- NPI 1821019571
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196985600000",
"number": "1366550519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3130",
"city": "OCALA",
"state": "FL",
"postal_code": "344783130",
"telephone_number": "352-867-8311",
"fax_number": "352-867-1053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 WATERMAN WAY",
"city": "TAVARES",
"state": "FL",
"postal_code": "327785266",
"telephone_number": "352-253-3333",
"fax_number": "352-589-3487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUDDENDORF",
"first_name": "KENNETH",
"middle_name": "A",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2007-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "FL",
"license": "ME86582",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "78596",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; 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.