Kenneth P Walworth III, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007136 Issued in MI

Practice address

721 N Shiawassee St Ste 201
Owosso, MI 48867-1632

Phone

(989) 725-8124

Fax

(989) 723-1205

NPI assigned

Sep 17, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Edward W Sparrow Hospital AssociationGroup PAC ID 6709799166, 698 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kennethwalworth@cua.allscriptsdirect.net

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.

• Edward W. Sparrow Hospital Association

  • Clinical Social Worker
  • Lansing, MI
  • NPI 1033165790
  Medicare reassignment Care Compare group NPD
• Mid-Michigan Behavioral Health, PC

  • Psychiatry Physician
  • Owosso, MI
  • NPI 1083823835
  Medicare reassignment
• Edward W Sparrow Hospital Association

  • Adult Health Nurse Practitioner
  • Lansing, MI
  • NPI 1265220438
  NPD
• Edward W. Sparrow Hospital Association

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lansing, MI
  • NPI 1033162326
  NPD (past)
• Edward W. Sparrow Hospital Association

  • Community/Retail Pharmacy
  • Carson City, MI
  • NPI 1093719783
  NPD (past)
• Memorial Hospital

  • Anesthesiology Physician
  • Owosso, MI
  • NPI 1659527737
  NPD (past)

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

• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711
  Care Compare affiliation
• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1760710719
  Care Compare affiliation

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1881096196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 W SAGINAW ST",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489151927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 N SHIAWASSEE ST STE 201",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488671632",
            "telephone_number": "989-725-8124",
            "fax_number": "989-723-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALWORTH",
        "first_name": "KENNETH",
        "middle_name": "P",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-17",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881096196",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Walsh, BSHA
• Brenden Walter, DDS
• Erin Elizabeth Walter
• Tatiana Walters
• Aimee Waltz
• Melissa Walz, BA
• Christopher Ward, CRNA
• Jared Ward
• Baylie Warner
• Karrie Warren

• Physician Assistant in Owosso, MI
• Providers in Owosso, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.