Kenneth John Bannon, BSPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA001023L Issued in PA

Practice address

111 Salem Avenue
Suite 302
Carbondale, PA 18407-2574

Phone

(570) 282-2031

Fax

(570) 282-2534

NPI assigned

May 1, 2006

Sex

Male

Sole proprietor

No

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.

• Delaware Center for Digestive Care LLC

  • Gastroenterology Physician
  • Newark, DE
  • NPI 1558722561

  DE

  Medicare reassignment Care Compare group
• Whites Crossing Medical Group Inc

  • Internal Medicine Physician
  • Carbondale, PA
  • NPI 1649242660

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bayhealth Medical Center, Inc.

  • General Acute Care Hospital
  • Milford, DE
  • NPI 1023006434

  Hospital

  Care Compare affiliation
• Beebe Medical Center, Inc.

  • General Acute Care Hospital
  • Lewes, DE
  • NPI 1821196486

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Delaware Center for Digestive Care LLC 68 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beebe Medical Center Hospital, Lewes, DE, CCN 080007
• Bayhealth Hospital, Sussex Campus Hospital, Milford, DE, CCN 080009

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 23, 2015.

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1821055047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SALEM AVENUE",
            "address_2": "SUITE 302",
            "city": "CARBONDALE",
            "state": "PA",
            "postal_code": "184072574",
            "telephone_number": "570-282-2031",
            "fax_number": "570-282-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNON",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "BSPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA001023L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arun J Shingala MD PC
• Aventura at Creekside LLC
• Andrew Babcanec, DPT
• Jillian Suzanne Bair, BCBA, LBS
• Leigh Fliedner Bales, MSPT
• Michael F Barkley, DPT
• Tamrat Bekele, MD
• William Michael Belcastro, DDS
• Brianna Marie Bennici
• Aaron Best, MA

• All providers in Carbondale, PA
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; 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.
• 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.