Kenneth W. Anderson, M.D.
Individual provider
Active NPI
Internal Medicine Physician · Lebanon, TN
NPI 1467545541 · NPPES record last updated Mar 18, 2017
Key facts
- NPI
- 1467545541
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD012869 (TN)
- Practice address
- 501 Park Ave
Suite C
Lebanon, TN 37087-1706
- Phone
- (615) 444-4070
- Fax
- (615) 444-4099
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
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.
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|
Gentiva II
Nashville, TN · CCN 441553 |
Hospice |
Contracted Managing Employee |
Feb 7, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20080724000202 |
TN |
Practitioner - Family Practice |
9537232517 |
Practice locations: Lebanon, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|
| MD012869 | TN | MD | Internal Medicine Physician |
| 12869 | TN | MD | Physical Therapist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Internal Medicine Physician |
207R00000X |
MD012869 |
TN |
Yes |
Addresses
Primary practice location
501 Park Ave
Suite C
Lebanon, TN 37087-1706
Mailing address
PO Box 190
Lebanon, TN 37088-0190
Phone (615) 444-4070
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 40326 | Other | TN | BCBS |
| 3010646 | Medicaid | TN | |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.
Verify at the official NPI Registry.