Active NPI
Kenneth Lee Willeford, M.D.
- Physical Medicine & Rehabilitation Physician
- Supply, NC
National Provider Identifier
1912917865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 36621
- Practice address
- 10 Doctors Cir
Suite 2
Supply, NC 28462-4089 - Phone
- (910) 755-6060
- Fax
- (910) 939-1659
- NPI assigned
- Aug 9, 2006
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 36621 | NC | Primary |
Addresses
Primary practice location
10 Doctors Cir
Suite 2
Supply, NC 28462-4089
Mailing address
10 Doctors Cir
Suite 2
Supply, NC 28462-4089
Phone (910) 755-6060
Other practice location 1
416 Main St
North Myrtle Beach, SC 29582-3024
Phone (910) 755-6060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016UX | Other | NC | BCBS NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC, SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041018000324 | NC | Practitioner - Interventional Pain Management | 3375503089 | Reassigns benefits to 1 organization |
| I20241115000079 | SC | Practitioner - Pain Management | 3375503089 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Pain Management
- Education
- George Washington University School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
10 Doctors Cir
Suite 2
Supply, NC 28462-4218
Phone (910) 755-6060
416 Main St
North Myrtle Beach, SC 29582-3024
Phone (910) 755-6060
Hospital & facility affiliations
- Novant Health Brunswick Medical Center
- J Arthur Dosher Memorial Hospital
- Novant Health New Hanover Regional Medical Center
- McLeod Loris Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.3 of 100
- Quality
- 80.6
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36621 | NC | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Carolinas Integrated Medicine PA | Current | Accepting new patients | |
| Coastal Carolinas Integrated Medicine II | Past | Accepting new patients |
Locations
10 Doctors Cir
Ste 2
Supply, NC 28462
Phone (910) 755-6060
416 Main St
North Myrtle Beach, SC 29582
Phone (843) 663-0933
Organizations & group practices 2
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.
-
- Pain Medicine (Physical Medicine & Rehabilitation) Physician
- Supply, NC
- NPI 1649304239
NC, SC
-
- Family Nurse Practitioner
- North Myrtle Beach, SC
- NPI 1255158788
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Rural Health Clinic/Center
- Oak Island, NC
- NPI 1235405358
Hospital
-
- General Practice Physician
- Bald Head Island, NC
- NPI 1376961219
Hospital
-
- General Acute Care Hospital
- Wilmington, NC
- NPI 1376139139
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752019200000",
"number": "1912917865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 DOCTORS CIR",
"address_2": "SUITE 2",
"city": "SUPPLY",
"state": "NC",
"postal_code": "284624089",
"telephone_number": "910-755-6060",
"fax_number": "910-755-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 DOCTORS CIR",
"address_2": "SUITE 2",
"city": "SUPPLY",
"state": "NC",
"postal_code": "284624089",
"telephone_number": "910-755-6060",
"fax_number": "910-939-1659"
}
],
"practiceLocations": [
{
"address_1": "416 Main St",
"address_purpose": "LOCATION",
"city": "North Myrtle Beach",
"state": "SC",
"postal_code": "295823024",
"country_code": "US",
"telephone_number": "910-755-6060",
"fax_number": "910-939-1659",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLEFORD",
"first_name": "KENNETH",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2025-07-09",
"certification_date": "2025-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NC",
"license": "36621",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "016UX",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Supply, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; 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.