Active NPI
Kenneth W Anderson, MD
- Pediatrics Physician
- West Des Moines, IA
National Provider Identifier
1851377899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 19114
- Practice address
- 6000 University Ave
Ste 100
West Des Moines, IA 50266-8203 - Phone
- (515) 241-2500
- Fax
- (515) 241-2505
- NPI assigned
- Dec 21, 2005
- Last updated
- Mar 7, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 19114 | IA | Primary |
Addresses
Primary practice location
6000 University Ave
Ste 100
West Des Moines, IA 50266-8203
Mailing address
6000 University Ave
Ste 100
West Des Moines, IA 50266-8203
Phone (515) 241-2500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851377899 | Medicaid | IA | |
| 370033541 | Other | IA | RR MEDICARE |
| 0098137 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19114 | IA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unitypoint at Home | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1851377899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6000 UNIVERSITY AVE",
"address_2": "STE 100",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502668203",
"telephone_number": "515-241-2500",
"fax_number": "515-241-2505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6000 UNIVERSITY AVE",
"address_2": "STE 100",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502668203",
"telephone_number": "515-241-2500",
"fax_number": "515-241-2505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KENNETH",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-21",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IA",
"license": "19114",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1851377899",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "370033541",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0098137",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.