Active NPI
Kenneth Robert McElynn, M.D.
- Family Medicine Physician
- Melbourne, FL
National Provider Identifier
1639217870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME85264
- Practice address
- 7925 N Wickham Rd Ste B
Melbourne, FL 32940-8211 - Phone
- (321) 633-8630
- Fax
- (321) 633-8631
- NPI assigned
- Feb 1, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME85264 | FL | Primary |
Addresses
Primary practice location
7925 N Wickham Rd Ste B
Melbourne, FL 32940-8211
Mailing address
805 Century Medical Dr Ste C
Titusville, FL 32796-2100
Phone (321) 268-6264
Other practice location 1
390 Challenger Rd
Cape Canaveral, FL 32920-4200
Phone (321) 633-8640
Other practice location 2
7000 Spyglass Court
Suite # 130
Melbourne, FL 32940-7948
Phone (321) 751-7113
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010431900 | Medicaid | FL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1639217870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 CENTURY MEDICAL DR STE C",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327962100",
"telephone_number": "321-268-6264",
"fax_number": "321-268-6273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7925 N WICKHAM RD STE B",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329408211",
"telephone_number": "321-633-8630",
"fax_number": "321-633-8631"
}
],
"practiceLocations": [
{
"address_1": "390 Challenger Rd",
"address_purpose": "LOCATION",
"city": "Cape Canaveral",
"state": "FL",
"postal_code": "329204200",
"country_code": "US",
"telephone_number": "321-633-8640",
"fax_number": "321-633-8641",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7000 Spyglass Court",
"address_2": "Suite # 130",
"address_purpose": "LOCATION",
"city": "Melbourne",
"state": "FL",
"postal_code": "329407948",
"country_code": "US",
"telephone_number": "321-751-7113",
"fax_number": "321-751-7114",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCELYNN",
"first_name": "KENNETH",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-01",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME85264",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010431900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.