Kenneth S Gillespie, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

979 Issued in WV

Practice address

75 Avenue B
Richwood, WV 26261-1236

Phone

(304) 846-2573

Fax

(304) 846-4657

NPI assigned

May 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgillespie1210826@valleyhealth.direct-ci.com

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.

• Appalachian Mountains Medical, LLC

  • Emergency Medicine Physician
  • Welch, WV
  • NPI 1881023117
  Medicare reassignment
• Amery Regional Medical Center, Inc.

  dba Amery Hospital & Clinic

  • Critical Access Hospital
  • Amery, WI
  • NPI 1093763518
  NPD
• Amery Regional Medical Center, Inc.

  dba Amery Hospital & Clinic - Luck

  • Rural Health Clinic/Center
  • Luck, WI
  • NPI 1851345268

  Physician Assistant

  NPD
• Cherokee Emergency Services, Inc.

  • Emergency Medicine Physician
  • Beckley, WV
  • NPI 1982643938

  Physician Assistant

  NPD (past)
• Kelly Medical Services Corporation LLC

  dba Kelly Medical Corporation

  • Emergency Medicine Physician
  • Welch, WV
  • NPI 1033154810
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System-Bloomer

  • Critical Access Hospital
  • Bloomer, WI
  • NPI 1700837812
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System-Barron

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  NPD (past)

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1912952193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "BEAVER",
            "state": "WV",
            "postal_code": "258130096",
            "telephone_number": "304-763-5167",
            "fax_number": "304-763-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 AVENUE B",
            "city": "RICHWOOD",
            "state": "WV",
            "postal_code": "262611236",
            "telephone_number": "304-846-2573",
            "fax_number": "304-846-4657"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4061 Old Peshtigo Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433887",
            "country_code": "US",
            "telephone_number": "715-732-8090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLESPIE",
        "first_name": "KENNETH",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "979",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2474-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgillespie306977@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cornerstone Family Pharmacy LLC
• Jerrica Jo Dempsey
• Richard W Dennison
• Clemente Campos Diaz, MD
• Elizabeth Dowdy
• Ian Gladwell, PHARM.D
• Jennifer Roselea Groves
• Joelene Groves, PA
• Thomas M Hewitt
• Sean Roger Hickey, RPH

• Physician Assistant in Richwood, WV
• Providers in Richwood, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.