Kenneth Dean Richard Dabolt, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

022107-1 Issued in NY

Practice address

224 E Main St
Springville, NY 14141-1443

Phone

(716) 592-8140

NPI assigned

Jun 28, 2018

Last updated

Jun 28, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NY

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bertrand Chaffee HospitalGroup PAC ID 0840273496, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bertrand Chaffee Hospital Hospital, Springville, NY, CCN 330111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Bertrand Chaffee Hospital

  • General Acute Care Hospital
  • Springville, NY
  • NPI 1275553521
  Medicare reassignment Care Compare group

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

• Bertrand Chaffee Hospital

  • General Acute Care Hospital
  • Springville, NY
  • NPI 1275553521
  Care Compare affiliation

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1881189116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 E MAIN ST",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411443",
            "telephone_number": "716-592-8140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 E MAIN ST",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411443",
            "telephone_number": "716-592-8140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABOLT",
        "first_name": "KENNETH",
        "middle_name": "DEAN RICHARD",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022107-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liana Fiorella Cummiskey, OTR
• Jennifer Lynn Cuneo, FNP
• Cara Rae Czechowski, DC
• Maria E. Czechowski, OTR
• Lisette Anne D'Eon, MD
• Priscilla K Dale, M.D.
• Dalip K. Khurana, M.D., PLLC
• Tammy Lyn Davis
• Mikelle Demmerley
• Gordon Dietz, CRNA

• Physician Assistant in Springville, NY
• Providers in Springville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; 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.