Kenneth G. Davis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E0876 Issued in TX

Practice address

605 S Conroe Medical Dr
Conroe, TX 77304-4722

Phone

(936) 539-4004

Fax

(936) 521-3964

NPI assigned

Oct 5, 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 2

Medicare fee-for-service enrollment

Enrolled in TX

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 PracticeAlso: Addiction Medicine

Education

University of Texas Medical Branch at Galveston, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lone Star Community Health Center, IncGroup PAC ID 7416841994, 35 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kennethdavis@lsfhc.allscriptsdirect.net
• Direct secure messaging: kenneth.davis.1@31617.direct.athenahealth.com

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.

• Lone Star Community Health Center, Inc.

  • Family Medicine Physician
  • Conroe, TX
  • NPI 1568590610
  Medicare reassignment Care Compare group NPD
• Lone Star Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Magnolia, TX
  • NPI 1710857131
  NPD
• Sadler Clinic Association

  • Multi-Specialty Clinic/Center
  • Conroe, TX
  • NPI 1114979127
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1639265010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722",
            "telephone_number": "936-539-4004",
            "fax_number": "936-539-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722",
            "telephone_number": "936-539-4004",
            "fax_number": "936-521-3964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KENNETH",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E0876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125758909",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125758603",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Davis
• Arlena Faye Davis
• Bill Jack Davis, M.A
• Briana Davis, PTA
• Chris Blake Davis, D.C.
• Michael Len Davis, DC
• Shannon Marie Davis
• Oscar Dayaon, OTR
• Jireh Gillian De la Cruz
• Janna De Los Santos

• Family Medicine Physician in Conroe, TX
• Providers in Conroe, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.