Kenneth Allan Shane, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

36002062 Issued in OH

Practice address

3381 Montrose Avenue
Akron, OH 44333-2411

Phone

(330) 666-6801

Fax

(330) 666-6801

NPI assigned

Feb 27, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Gates Mills Assisted Living LLC

  • Assisted Living Facility
  • Mayfield Heights, OH
  • NPI 1649764945
  NPD (past)
• Hospice of the Western Reserve, Inc.

  • Pediatric Hospice and Palliative Medicine Physician
  • Cleveland, OH
  • NPI 1255333753
  NPD (past)
• The Ursuline Academy of Cleveland

  • Skilled Nursing Facility
  • Pepper Pike, OH
  • NPI 1710011820
  NPD (past)

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309737600000",
    "number": "1790812188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3381 MONTROSE AVENUE",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443332411",
            "telephone_number": "330-666-6801",
            "fax_number": "330-666-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3381 MONTROSE AVENUE",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443332411",
            "telephone_number": "330-666-6801",
            "fax_number": "330-666-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANE",
        "first_name": "KENNETH",
        "middle_name": "ALLAN",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2011-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36002062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0561682",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480003668",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "000000132340",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007763250",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED AMERICAN INSURANCE",
            "identifier": "341466072",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STANDARD LIFE AND ACCIDEN",
            "identifier": "SH0520022",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "000000165933",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amir H Shahideh, MD
• Connie Shambaugh
• Terrence Shambley
• Robin Shamburger
• Suzanne Renee Shammo, RD, LD
• Ryan Michael Shaner
• Breanne Shank, MSN, APRN, FNP-BC
• Alicia Marie Shanks
• Kelsey Shanks, OT
• Amber Christian Shannon, LPN

• Podiatrist in Akron, OH
• Providers in Akron, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.