Active NPI
Kenneth M Brantley, MD
- Critical Care Medicine (Internal Medicine) Physician
- Indianapolis, IN
National Provider Identifier
1609825017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine (Internal Medicine) Physician
- License
- 01071672A
- Practice address
- 1801 N Senate Blvd
Ste 230
Indianapolis, IN 46202-1252 - Phone
- (317) 962-5820
- Fax
- (317) 962-3916
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 6726 | NV | |
| Pulmonary Disease Physician | 207RP1001X | 6726 | NV | |
| Pulmonary Disease Physician | 207RP1001X | 01071672A | IN | |
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 01071672A | IN | Primary |
Addresses
Primary practice location
1801 N Senate Blvd
Ste 230
Indianapolis, IN 46202-1252
Mailing address
250 N Shadeland Ave
Ste 130 - Provider Enrollment
Indianapolis, IN 46219-4959
Other practice location 1
1155 Mill St
Reno, NV 89502-1576
Phone (775) 982-7878
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2019408 | Medicaid | NV | |
| 201165820 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6726 | NV | MD | Critical Care Medicine (Internal Medicine) Physician |
| 01071672A | IN | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multicare Health System | Current | Accepting new patients | |
| Pulmonary Associates, Inc. | Pulmonary Disease | Past | Accepting new patients |
Interoperability endpoints
- kbrantly834719@direct.ochin.org
- https://fhir4.healow.com/fhir/r4/BCIBCA
Organizations & group practices 2
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.
-
- Neurological Surgery Physician
- Tacoma, WA
- NPI 1497766638
-
- Pulmonary Disease Physician
- Las Vegas, NV
- NPI 1952436115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581033600000",
"number": "1609825017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"address_2": "STE 130 - PROVIDER ENROLLMENT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 N SENATE BLVD",
"address_2": "STE 230",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462021252",
"telephone_number": "317-962-5820",
"fax_number": "317-962-3916"
}
],
"practiceLocations": [
{
"address_1": "1155 Mill St",
"address_purpose": "LOCATION",
"city": "Reno",
"state": "NV",
"postal_code": "895021576",
"country_code": "US",
"telephone_number": "775-982-7878",
"fax_number": "775-982-4196",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRANTLEY",
"first_name": "KENNETH",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2020-02-07",
"certification_date": "2020-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "NV",
"license": "6726",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "NV",
"license": "6726",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "IN",
"license": "01071672A",
"primary": false
},
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "IN",
"license": "01071672A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2019408",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201165820",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.