Kyle R Allen, DO
Individual provider Active NPI Geriatric Medicine (Family Medicine) Physician · Xenia, OH
NPI 1821058736 · NPPES record last updated Nov 30, 2022
Key facts
- NPI
- 1821058736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 207QG0300X
- License
- 34.004461 (OH)
- Practice address
- 2424 Valhalla CT
Xenia, OH 45385-8906 - Phone
- (330) 606-1971
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, DE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Patriot Home Care |
Hospice | Corporate Officer Corporate Director |
May 1, 2022 May 4, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230811000062 | PA | Practitioner - Internal Medicine |
2961416649 | |
| I20240119000344 | DE | Practitioner - Geriatric Medicine |
2961416649 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34.004461 | OH | MD | Geriatric Medicine (Family Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 0102202933 | VA | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 34.004461 | OH | Yes |
Addresses
Primary practice location
2424 Valhalla CT
Xenia, OH 45385-8906
Mailing address
2424 Valhalla CT
Xenia, OH 45385-8906
Phone (330) 606-1971
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821058736 | Medicaid | VA |
Other providers in Xenia, OH
- Jasmine Alexander
- Esam Alkhawaga
- Allen & Carmens Caring Hands LLC
- Brandi Allen
- Denise Allen
- Tara Allen
- Alliance Physicians Inc
- Alliance Physicians, Inc.
- Alliance Physicians, Inc.
- Jaiden Alloy
All providers in Xenia, OH · Geriatric Medicine (Family Medicine) Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.