NPIMap

Individual provider Active NPI

Kenneth B Anderson, PA-C

  • Medical Physician Assistant
  • Salem, VA
National Provider Identifier
1497868699
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110840603 Issued in VA
Practice address
1935 W Main St
Salem, VA 24153-3109
Phone
(540) 387-0441
Fax
(540) 389-7868
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110840603 VA Primary

Addresses

Primary practice location

1935 W Main St
Salem, VA 24153-3109

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713

Other identifiers 2

IdentifierTypeStateIssuer
008932395MedicaidVA
0110840603OtherVASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100204000740 VA Practitioner - Physician Assistant 6901949536 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Practice addresses (Care Compare)

1935 W Main St
Salem, VA 24153-3109
Phone (540) 387-0441

1955 W Main St
Salem, VA 24153-3109
Phone (540) 387-0441

6415 Peters Creek Rd
Roanoke, VA 24019-4021
Phone (703) 562-2110

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Roanoke, VA, CCN 497429
  • Amedisys Home Health Care Home health agency, Roanoke, VA, CCN 497275
  • Good Samaritan Hospice Inc Hospice, Roanoke, VA, CCN 491510
  • Carilion Medical Center Hospital, Roanoke, VA, CCN 490024
  • Lewisgale Medical Center Hospital, Salem, VA, CCN 490048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Healthcare Corporation CurrentSince May 13, 2024 Accepting new patients
Carilion Healthcare Corporation CurrentSince May 13, 2024 Accepting new patients
Blue Ridge Healthcare Partners, LLC Past Accepting new patients

Locations

434 Peppers Fry Rd NW
Christiansburg, VA 24073
Phone (540) 382-6000

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

1935 W Main St
Salem, VA 24153
Phone (540) 302-0190

150 Spartan Dr
Salem, VA 24153
Phone (540) 382-4221

1955 W Main St
Salem, VA 24153
Phone (540) 302-0192

Interoperability endpoints

  • Direct secure messaging: kanderson69218@direct.carilionclinic.org

Organizations & group practices 10

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1497868699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 W MAIN ST",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241533109",
            "telephone_number": "540-387-0441",
            "fax_number": "540-389-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KENNETH",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110840603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008932395",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0110840603",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

Verify at the official NPI Registry.