Organization Active NPI

Kennebec Internal Medicine Associates, P.a.

  • Internal Medicine Physician
  • Augusta, ME
National Provider Identifier
1811108699
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
KENNEBEC INTERNAL MEDICINE ASSOCIATES, P.A.
Practice address
9 Glenridge Dr
Augusta, ME 04330-6605
Phone
(207) 623-8434
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kevin Kane
Title
M.D.
Phone
(207) 623-8434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9 Glenridge Dr
Augusta, ME 04330-6605

Mailing address

9 Glenridge Dr
Augusta, ME 04330-6605
Phone (207) 623-8434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080327000115 ME Part B Supplier - Clinic/Group Practice 2860578168 Receives reassigned benefits from 3 practitioners
Practice locations: Augusta, ME

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D0089175Kennebec Internal Medicine Associates, PA9 Glenridge Drive, Augusta, ME 04330ComplianceJul 15, 2027

National Provider Directory

National Provider Directory

Locations

9 Glenridge Dr
Augusta, ME 04330
Phone (207) 623-8434

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811108699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GLENRIDGE DR",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043306605",
            "telephone_number": "207-623-8434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 GLENRIDGE DR",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043306605",
            "telephone_number": "207-623-8434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEBEC INTERNAL MEDICINE ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KANE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "207-623-8434"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, ME

Sources for this page

  • 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.