Kenneth Donald Elman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G72087 Issued in CA

Practice address

29525 Canwood St
#305
Agoura Hills, CA 91301-4233

Phone

(818) 707-7789

Fax

(818) 707-7797

NPI assigned

Aug 1, 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 4

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Family Practice

Education

Wayne State University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Barry Jay Wallman

  • Family Medicine Physician
  • Agoura Hills, CA
  • NPI 1952318461
  Medicare reassignment

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429660800000",
    "number": "1528075751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST",
            "address_2": "#305",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014233",
            "telephone_number": "818-707-7789",
            "fax_number": "818-707-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST",
            "address_2": "#305",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014233",
            "telephone_number": "818-707-7789",
            "fax_number": "818-707-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMAN",
        "first_name": "KENNETH",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G72087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "CB227753",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CB227752",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1952318461",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1528075751",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wilford Kyle Eiteman-Pang, DPT
• Elevation Behavioral Health
• Elevation Behavioral Health (Elevations)
• Tyler James Elias, LMFT
• Joeline Ellison, FNP
• Embrace Progressive Therapy Inc
• Empire Medical Specialist
• Empowering Minds Together Inc
• Moises Enghelberg, D.O.
• Ergonomically Correct, Inc.

• Family Medicine Physician in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.