NPIMap

Organization Active NPI

Kenneth H. Davidson, MD, PC

  • Cardiovascular Disease Physician
  • Rochester, NY
National Provider Identifier
1457547184
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
103663 Issued in NY
Legal business name
KENNETH H. DAVIDSON, MD, PC
Practice address
1415 Portland Ave
Suite 350
Rochester, NY 14621-3038
Phone
(585) 426-9278
Fax
(585) 338-2738
NPI assigned
Sep 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

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

Authorized official

Name
Dr. Kenneth Davidson, MDNPI 1871565861
Title
President
Phone
(585) 426-9278

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 103663 NY Primary

Addresses

Primary practice location

1415 Portland Ave
Suite 350
Rochester, NY 14621-3038

Mailing address

1415 Portland Ave
Suite 350
Rochester, NY 14621-3038
Phone (585) 426-9278

Other identifiers 10

IdentifierTypeStateIssuer
Y019296OtherCHAMPUS
00450853MedicaidNY
10453OtherGHI
4273339OtherAETNA
9913OtherBLUE CROSS BLUE SHIELD
PO10103663OtherBLUE CHOICE - EXCELLUS
005002871OtherBLUE SHIELD WESTERN NY
005002871OtherCOMMUNITY BLUE
07341OtherCHOICE CARE
MD4426OtherPREFERRED CARE

National Provider Directory

National Provider Directory

Locations

1445 Portland Ave
Ste 104
Rochester, NY 14621
Phone (585) 426-9278

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381276800000",
    "number": "1457547184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "address_2": "SUITE 350",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-426-9278",
            "fax_number": "585-338-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "address_2": "SUITE 350",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-426-9278",
            "fax_number": "585-338-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH H. DAVIDSON, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2013-10-09",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-426-9278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "103663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "Y019296",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00450853",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "10453",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4273339",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9913",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE - EXCELLUS",
            "identifier": "PO10103663",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD WESTERN NY",
            "identifier": "005002871",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY BLUE",
            "identifier": "005002871",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHOICE CARE",
            "identifier": "07341",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "MD4426",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.