Kasey Laz Abanonu Jr., MD
Individual provider Active NPI Internal Medicine Physician · Las Vegas, NV
NPI 1609109644 · NPPES record last updated Dec 2, 2022
Key facts
- NPI
- 1609109644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 14139 (NV)
- Practice address
- 4919 W Craig Rd
Las Vegas, NV 89130-2730 - Phone
- (725) 220-8706
- Fax
- (833) 749-0366
- NPI assigned
- Sep 9, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Centerwell Senior Primary Care NV P C
Practice addresses (Care Compare)
4919 W Craig Rd
Las Vegas, NV 89130-2730
Phone (725) 220-8706
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- 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 |
|---|---|---|---|---|
| I20120517000595 | NV | Practitioner - Internal Medicine | 7113063173 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14139 | NV | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centerwell Senior Primary Care (NV) PC | Family Medicine | Current |
Accepting new patients |
| Centerwell Senior Primary Care (NV) PC | Family Medicine | Current |
Accepting new patients |
| DCH Provider Services, LLC | Past | Accepting new patients | |
| Centennial Hills Hospital Medical Center | Past | Accepting new patients | |
| Dignity Health | Past | Accepting new patients | |
| Sunrise Mountainview Hospital, Inc. | Past | Accepting new patients | |
| Centerwell Senior Primary Care (NV) PC | Family Medicine | Past | Accepting new patients |
| Centerwell Senior Primary Care NV P C | Family Medicine | Past | Accepting new patients |
| Hospital Medicine Associates LLC | Family Medicine | Past | Accepting new patients |
| Dignity Health | Past | Accepting new patients | |
| Inpatient Consultants of Nevada, Inc. a Medical Corporation | Internal Medicine | Past | Accepting new patients |
| Desert Springs Hospital | Past | Accepting new patients |
Locations
6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836
4700 Millenia Blvd
Ste 650
Orlando, FL 32839
Phone (407) 533-6837
10180 W Tropicana Ave
Ste 136
Las Vegas, NV 89147
Phone (702) 848-3554
4001 S Decatur Blvd
Ste 25
Las Vegas, NV 89103
Phone (725) 224-6967
4919 W Craig Rd
Las Vegas, NV 89130
Phone (725) 220-8706
3129 N Rainbow Blvd
Las Vegas, NV 89108
Phone (725) 220-8457
Interoperability endpoints
- kasey.abanonu@centerwell.eclinicaldirectplus.com
- kasey.abanonu.1@29601.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 14139 | NV | Yes |
Addresses
Primary practice location
4919 W Craig Rd
Las Vegas, NV 89130-2730
Mailing address
4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (725) 220-8706
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609109644 | Medicaid | NV | |
| V75834 | Other | NV | MEDICARE |
Other providers in Las Vegas, NV
- Marcial Lopez Abalos
- Mina Abalos
- Rachel Abalos
- Aban Medical Services
- Abandoned Babies Christian Ministries
- Ivy Marie Abante
- Reymar Abante
- Levi Luke Manuel Abao
- Nuhamin Abaoli
- Lyle Anthony Agoncillo Abapo
All providers in Las Vegas, NV · Internal Medicine Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2022. 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.