Kanouse Medical Group PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD-036479-E Issued in PA

Legal business name

KANOUSE MEDICAL GROUP PC

Practice address

695 E 16TH St
Suite D
Berwick, PA 18603-2320

Phone

(570) 752-5500

Fax

(570) 752-6790

NPI assigned

Nov 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gary Douglas Kanouse, MDNPI 1568521425

Title

Physician

Phone

(570) 752-5500

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary Douglas Kanouse, M.D.

  • Internal Medicine Physician
  • Berwick, PA
  • NPI 1568521425
  Medicare reassignment NPD Authorized official
• Russell C Hendershot, DO, MS, MPH

  • Family Medicine Physician
  • Pennsburg, PA
  • NPI 1568548675
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790859783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 E 16TH ST",
            "address_2": "SUITE D",
            "city": "BERWICK",
            "state": "PA",
            "postal_code": "186032320",
            "telephone_number": "570-752-5500",
            "fax_number": "570-752-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 E 16TH ST",
            "address_2": "SUITE D",
            "city": "BERWICK",
            "state": "PA",
            "postal_code": "186032320",
            "telephone_number": "570-752-5500",
            "fax_number": "570-752-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANOUSE MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KANOUSE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "570-752-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD-036479-E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50002681",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1335094",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roslon Johnson, CRNP
• Deborah Ann Justice, R.D., L.D.N.
• Mona D Justo, MD
• Joanne R Kalie, PHARM D.
• Amy Kaminski, DMD
• Gary Douglas Kanouse, M.D.
• Mark B. Kelchner, D.D.S.
• Kimberly Kepner, LMSW
• Keystone Rehabilitation Systems Inc (Keystone Rehabilitation Systems)
• Brandon Kishbaugh, PT

• Internal Medicine Physician in Berwick, PA
• Providers in Berwick, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.