Individual provider Active NPI

Foma Munoh Kenne, M.D

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1972039378
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
306429 Issued in NY
Practice address
355 Bard Ave
Villa BLDG 1St Floor
Staten Island, NY 10310-1664
Phone
(718) 818-2419
NPI assigned
May 4, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 306429 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 0101270130 VA

Addresses

Primary practice location

355 Bard Ave
Villa BLDG 1St Floor
Staten Island, NY 10310-1664

Mailing address

355 Bard Ave Dept of
Villa BLDG 1St Floor
Staten Island, NY 10310-1664
Phone (718) 818-2419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NM2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210104001330 NY Practitioner - Internal Medicine 9133532559 Reassigns benefits to 1 organization
I20230809001358 NM Practitioner - Hematology/Oncology 9133532559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

8300 Constitution Ave NE
BLDG D
Albuquerque, NM 87110-7613
Phone (505) 291-2200

Hospital & facility affiliations

  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021
  • Socorro General Hospital Hospital, Socorro, NM, CCN 321301

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101270130VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Presbyterian Healthcare Services Internal Medicine Current Accepting new patients
Amboy Medical Practice PC Internal Medicine CurrentSince Nov 2, 2020 Accepting new patients
Amboy Medical Practice PC CurrentSince Nov 2, 2020 Accepting new patients
Presbyterian Healthcare Services Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients

Locations

8300 Constitution Ave NE
Bldg D
Albuquerque, NM 87110
Phone (505) 291-2200

4588 Paradise Blvd NW
Albuquerque, NM 87114
Phone (505) 923-2070

2100 N Mlk Blvd
Clovis, NM 88101
Phone (505) 769-2141

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

1010 Spruce St
Espanola, NM 87532
Phone (505) 367-0340

211 Sudderth Dr
Ruidoso, NM 88345
Phone (505) 257-7381

4801 Beckner Rd
Santa Fe, NM 87507
Phone (505) 772-1234

1202 Highway 60
Socorro, NM 87801
Phone (505) 835-1140

301 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-7000

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

355 Bard Ave
Bldg 1ST
Staten Island, NY 10310
Phone (718) 720-1222

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: fkenne235733@direct.phs.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1972039378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVE DEPT OF",
            "address_2": "VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "address_2": "VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNOH KENNE",
        "first_name": "FOMA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-04",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "306429",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101270130",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.