Max Calvin Kinnaman Jr., D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

02306 Issued in KY

Practice address

380 Suwannee Trail St
Bowling Green, KY 42103-7956

Phone

(270) 901-5000

Fax

(270) 842-5268

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

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

Des Moines University of Osteopathic Medicine and Health Sciences, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uhs of Bowling Green LLCGroup PAC ID 7810987336, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Uhs of Bowling Green LLC

  • Psychiatric Hospital
  • Bowling Green, KY
  • NPI 1396715967
  Medicare reassignment Care Compare group
• River Region Psychiatry Associates LLC

  • Psychiatry Physician
  • Montgomery, AL
  • NPI 1386891497

  KY

  Medicare reassignment NPD
• Abs Lincs Ky, LLC

  • Psychiatry Physician
  • Hopkinsville, KY
  • NPI 1720353501
  Medicare reassignment
• Lifeskills, Inc.

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1669401816
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1376693176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 SUWANNEE TRAIL ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037956",
            "telephone_number": "270-901-5000",
            "fax_number": "270-842-5268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 SUWANNEE TRAIL ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037956",
            "telephone_number": "270-901-5000",
            "fax_number": "270-842-5268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNAMAN",
        "first_name": "MAX",
        "middle_name": "CALVIN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "02306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30604011",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "0257",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64023062",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Demetrius King, LPCC
• Kasey King, CSA
• Michelle Leigh King
• Monica King, NP
• Seth Landon King, PA-C
• Kelly Kinney
• Taylor Brooke Kinslow, MS CCC SLP
• Kiosk Medicine Kentucky LLC
• Dustin Kirby
• Stacy Kirby, KCSA

• Psychiatry Physician in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Psychiatry Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; 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.