Kenneth Bryan Heller, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

09331 Issued in SC

Practice address

113 Wildwood Dr
Belton, SC 29627-9687

Phone

(864) 940-9701

Fax

(864) 338-8760

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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.

• South Carolina Dept of Mental Health Accounting

  • Skilled Nursing Facility
  • Florence, SC
  • NPI 1902476443

  SC

  Medicare reassignment NPD
• South Carolina Dept of Mental Health Accounting Office

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1083421994
  NPD
• South Carolina Dept of Mental Health Accounting Office

  • Internal Medicine Physician
  • Walterboro, SC
  • NPI 1780850891
  NPD

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187827200000",
    "number": "1477588655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846",
            "city": "BELTON",
            "state": "SC",
            "postal_code": "296270846",
            "telephone_number": "864-940-9701",
            "fax_number": "864-338-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 WILDWOOD DR",
            "city": "BELTON",
            "state": "SC",
            "postal_code": "296279687",
            "telephone_number": "864-940-9701",
            "fax_number": "864-338-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELLER",
        "first_name": "KENNETH",
        "middle_name": "BRYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "09331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093311",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Care Management, LLC
• Jonathan Alexander Fernandez, DMD
• Rachell Gaines
• Jarod Roy Haggard, DC
• Heart to Heart Therapeutic Services Inc
• Home Care Medical AIDS Inc
• Homecare Medical AIDS, Inc.
• Ashley E Hopkins, PHARM D
• Ingles Markets Inc
• Jarod R Haggard

• All providers in Belton, SC
• General Practice Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.