Individual provider Active NPI

Kenneth Clifford Whithaus, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Tallahassee, FL
National Provider Identifier
1619060787
Registry record updated Jun 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD.29340 Issued in AL
Practice address
1899 Eider CT
Tallahassee, FL 32308-4537
Phone
(850) 219-7640
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X R9321 AL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD.29340 AL Primary

Addresses

Primary practice location

1899 Eider CT
Tallahassee, FL 32308-4537

Mailing address

1899 Eider Court
Tallahassee, FL 32308-4537
Phone (850) 219-7640

Other identifiers 1

IdentifierTypeStateIssuer
ME 109950OtherFLME LICENCE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20110621000211 FL Practitioner - Pathology 4284812330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of South Florida College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1899 Eider CT
Tallahassee, FL 32308-4537
Phone (850) 878-5143

Hospital & facility affiliations

  • Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135
  • Jackson Hospital Hospital, Marianna, FL, CCN 100142
  • Doctors Memorial Hospital Inc Hospital, Perry, FL, CCN 101314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.29340ALMDAnatomic Pathology & Clinical Pathology Physician
R9321ALMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Ketchum Wood & Burgert Chartered DRS Ketchum Wood & Burgert CurrentSince Jul 5, 2011 Accepting new patients
Ketchum Wood & Burgert Chartered DRS Ketchum Wood & Burgert Anatomic Pathology & Clinical Pathology CurrentSince Jul 5, 2011 Accepting new patients

Locations

1899 Eider Ct
Tallahassee, FL 32308
Phone (850) 878-5143

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.

Hospital & facility affiliations 3

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307318400000",
    "number": "1619060787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1899 EIDER COURT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084537",
            "telephone_number": "850-219-7640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1899 EIDER CT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084537",
            "telephone_number": "850-219-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITHAUS",
        "first_name": "KENNETH",
        "middle_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AL",
            "license": "R9321",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AL",
            "license": "MD.29340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ME LICENCE NUMBER",
            "identifier": "ME 109950",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.