Kenneth Andrew Conrad, M.D.
Individual provider Active NPI Family Medicine Physician · Kings Bay, GA
NPI 1699762997 · NPPES record last updated Mar 18, 2010
Key facts
- NPI
- 1699762997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME 72302 (FL)
- Practice address
- 881 Uss James Madison Rd
Naval Branch Health Clinic
Kings Bay, GA 31547-2531 - Phone
- (912) 573-8801
- NPI assigned
- Oct 2, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20130621000376 | FL | Order and Referring Only - Family Practice |
1254329568 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 72302 | FL | MD | Family Medicine Physician |
| 01029429A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians Inc | Past | Accepting new patients | |
| Cajina Anesthesia, PA | Past | Accepting new patients | |
| Emergency Physicians Inc | Past |
Accepting new patients | |
| Shands Teaching Hospital and Clinics Inc | Past | Accepting new patients |
Interoperability endpoints
- ken.conrad.1@14027.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME 72302 | FL | Yes |
| Family Medicine Physician | 207Q00000X | 01029429A | IN |
Addresses
Primary practice location
881 Uss James Madison Rd
Naval Branch Health Clinic
Kings Bay, GA 31547-2531
Mailing address
877 Arthur Moore Dr
Green Cove Springs, FL 32043-9510
Phone (904) 282-2385
Other providers in Kings Bay, GA
- Thomas Alan Cade
- Norberto Caez
- Eleanor Lucero Capulong
- Jay D Carson
- William Kevin Conley II
- David F. Crawford
- Micheal Shane Curry
- Erica Lynn Day
- Barry Wayne Downing
- Briana Duckworth
All providers in Kings Bay, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2010. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.