Active NPI
Kenneth Edward Yaw, PA-C
- Physician Assistant
- Summerset, SD
National Provider Identifier
1982166377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1363
- Practice address
- 8064 Steamboat CT
Summerset, SD 57769-6213 - Phone
- (209) 601-0780
- NPI assigned
- Apr 3, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 7377 | AZ | |
| Physician Assistant | 363A00000X | 1363 | SD | Primary |
Addresses
Primary practice location
8064 Steamboat CT
Summerset, SD 57769-6213
Mailing address
8064 Steamboat CT
Summerset, SD 57769-6213
Phone (209) 601-0780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230124002148 | SD | Practitioner - Physician Assistant | 4789926213 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7377 | AZ | MD | Physician Assistant |
Interoperability endpoints
- kyaw@rwicl-sd.direct.office.nextgen.com
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1982166377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8064 STEAMBOAT CT",
"city": "SUMMERSET",
"state": "SD",
"postal_code": "577696213",
"telephone_number": "209-601-0780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8064 STEAMBOAT CT",
"city": "SUMMERSET",
"state": "SD",
"postal_code": "577696213",
"telephone_number": "209-601-0780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YAW",
"first_name": "KENNETH",
"middle_name": "EDWARD",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-03",
"last_updated": "2022-06-29",
"certification_date": "2022-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "7377",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "1363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerset, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.