NPIMap

Individual provider Active NPI

Kenneth Mitchum Maynard, D.O.

  • Family Medicine Physician
  • Lizton, IN
National Provider Identifier
1730103730
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02000836A Issued in IN
Practice address
1045 Wyatt Way
Lizton, IN 46149-9583
Phone
(317) 994-6600
Fax
(317) 994-6605
NPI assigned
Jul 26, 2006
Last updated
Mar 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02000836A IN Primary

Addresses

Primary practice location

1045 Wyatt Way
Lizton, IN 46149-9583

Mailing address

1100 Southfield Dr
Suite 1370
Plainfield, IN 46168-4498
Phone (317) 837-5571

Other identifiers 1

IdentifierTypeStateIssuer
200932990MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmaynard228389@direct-PRD.stelizabeth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1984
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1100 Southfield Dr
Suite 1370
Plainfield, IN 46168-4300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02000836AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hendricks County Hospital CurrentSince Jan 1, 2014 Accepting new patients
Hendricks County Hospital Current Accepting new patients
Hendricks County Hospital CurrentSince Jan 1, 2014 Accepting new patients
Hendricks County Hospital Family Medicine Past Accepting new patients
Indiana Urgent Care Centers, LLC Past Accepting new patients
Major Hospital Past Accepting new patients
Indianapolis Osteopathic Hospital Inc. Family Medicine Past Accepting new patients
Indianapolis Osteopathic Hospital, Inc Past Accepting new patients
St Francis Hospital and Health Centers Past Accepting new patients

Locations

8244 E US Highway 36
Ste 1100
Avon, IN 46123
Phone (317) 272-7500

8244 E US Highway 36
Ste 1340
Avon, IN 46123
Phone (317) 520-5510

321 E Northfield Dr
Ste 100
Brownsburg, IN 46112
Phone (317) 742-9025

1045 Wyatt Way
Lizton, IN 46149
Phone (317) 994-6600

1100 Southfield Dr
Ste 1370
Plainfield, IN 46168
Phone (317) 837-5570

Interoperability endpoints

  • FHIR API: https://sehproxy.stelizabeth.com/arr-fhir/api/FHIR/R4
  • Direct secure messaging: kenneth.maynard@377412657217540.direct.elationemr.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1730103730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SOUTHFIELD DR",
            "address_2": "SUITE 1370",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461684498",
            "telephone_number": "317-837-5571",
            "fax_number": "317-837-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 WYATT WAY",
            "city": "LIZTON",
            "state": "IN",
            "postal_code": "461499583",
            "telephone_number": "317-994-6600",
            "fax_number": "317-994-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "KENNETH",
        "middle_name": "MITCHUM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02000836A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200932990",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmaynard228389@direct-PRD.stelizabeth.com",
            "affiliation": "N",
            "address_1": "1045 Wyatt Way",
            "city": "Lizton",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461499583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lizton, IN

Sources for this page

Verify at the official NPI Registry.