NPIMap

Individual provider Active NPI

Nicholas George Kaknes, MD

  • Internal Medicine Physician
  • Roanoke, VA
National Provider Identifier
1740556471
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME124823 Issued in FL
Practice address
1824 9TH St SE Ste C
Roanoke, VA 24013-2902
Phone
(540) 595-9332
Fax
(540) 766-5456
NPI assigned
Mar 27, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X ME124823 FL
Internal Medicine Physician 207R00000X ME124823 FL Primary

Addresses

Primary practice location

1824 9TH St SE Ste C
Roanoke, VA 24013-2902

Mailing address

1824 9TH St SE Ste C
Roanoke, VA 24013-2902
Phone (540) 595-9332

Other practice location 1

1611 NW 12th Ave
Central 600-D
Miami, FL 33136-1005
Phone (786) 351-8388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240314001799 FL Practitioner - Internal Medicine 7618320284
I20240830001904 VA Practitioner - Internal Medicine 7618320284 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lewis Gale Physicians LLCGroup PAC ID 6507886231, 191 clinicians
Lake Spring Physician Services, LLCGroup PAC ID 1254689482, 89 clinicians

Practice addresses (Care Compare)

1802 Braeburn Dr
Salem, VA 24153-7357

1900 Electric Rd
Salem, VA 24153-7474
Phone (540) 776-4000

2155 Apperson Dr
Salem, VA 24153-7235
Phone (540) 444-2010

Hospital & facility affiliations

  • Lewisgale Medical Center Hospital, Salem, VA, CCN 490048
  • Lewisgale Hospital Alleghany Hospital, Low Moor, VA, CCN 490126
  • Lewisgale Hospital Montgomery Hospital, Blacksburg, VA, CCN 490110
  • Wythe County Community Hospital Hospital, Wytheville, VA, CCN 490111

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME124823FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premium Healthcare Holdings, LLLP CurrentSince Feb 27, 2024 Accepting new patients
Lake Spring Physician Services, LLC Hospitalist CurrentSince May 15, 2024 Accepting new patients
Glutox Health LLC Internal Medicine CurrentSince Jan 14, 2024 Accepting new patients
Hoover Family Medicine PA PastSince Feb 27, 2024 Accepting new patients

Locations

2400 SW 69th Ave
Ste 100
Miami, FL 33155

1900 Electric Rd
Salem, VA 24153
Phone (540) 772-3400

Organizations & group practices 5

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 5

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": "1332806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762819200000",
    "number": "1740556471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 9TH ST SE STE C",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240132902",
            "telephone_number": "540-595-9332",
            "fax_number": "540-766-5456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 9TH ST SE STE C",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240132902",
            "telephone_number": "540-595-9332",
            "fax_number": "540-766-5456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1611 NW 12th Ave",
            "address_2": "Central 600-D",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331361005",
            "country_code": "US",
            "telephone_number": "786-351-8388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAKNES",
        "first_name": "NICHOLAS",
        "middle_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-27",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "ME124823",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME124823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.