Kenneth Kay Hines, M.D.
Individual provider Active NPI Diagnostic Radiology Physician · Daytona Beach, FL
NPI 1477512747 · NPPES record last updated Jun 13, 2023
Key facts
- NPI
- 1477512747
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- ME54914 (FL)
- Practice address
- 350 N Clyde Morris Blvd
Daytona Beach, FL 32114-2733 - Phone
- (386) 238-3229
- Fax
- (386) 238-3292
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- University of Florida College of Medicine, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Florida Health Care Plan Inc
Practice addresses (Care Compare)
320 N Clyde Morris Blvd
Daytona Beach, FL 32114-2744
Phone (386) 736-1948
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080529000730 | FL | Practitioner - Diagnostic Radiology | 7719970979 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME54914 | FL | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Health Care Plan, Inc | Current |
Accepting new patients | |
| Florida Health Care Plan, Inc | Current |
Accepting new patients | |
| Citrus Memorial Health Foundation Inc | Past | Accepting new patients | |
| Mandell & Blau, MD'S PC | Diagnostic Radiology | Past | Accepting new patients |
| Coastal Imaging LLC | Diagnostic Radiology | Past | Accepting new patients |
| Emery Sleep Solutions | Past | Accepting new patients | |
| Radiserv LLC | Diagnostic Radiology | Past | Accepting new patients |
Locations
350 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 238-3200
320 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 238-3200
309 Palm Coast Pkwy NE
Palm Coast, FL 32137
Phone (386) 445-7073
740 Dunlawton Ave
Ste 200
Port Orange, FL 32127
Phone (386) 763-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 44229 | CO | |
| Diagnostic Radiology Physician | 2085R0202X | M-9423 | ID | |
| Diagnostic Radiology Physician | 2085R0202X | ME54914 | FL | Yes |
Addresses
Primary practice location
350 N Clyde Morris Blvd
Daytona Beach, FL 32114-2733
Mailing address
350 N Clyde Morris Blvd
Daytona Beach, FL 32114-2733
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477512747 | Other | FL | TRICARE |
| 003325100 | Medicaid | FL | |
| 09285 | Other | FL | BCBS |
Other providers in Daytona Beach, FL
- Larhonda Hill
- Margaux Avila Hill
- Matthew Joseph Hill
- Quierre Hill
- Cori Hilt
- Sally Kathleen Hinman
- Charlotte F. Hinson
- Susan Hinson
- Cindy May Hird
- James K Hitchman
All providers in Daytona Beach, FL · Diagnostic Radiology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2023. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.