Physician Compare National (NPI:1043401672)

HEALTHCARE PROVIDER: KEVIN R KENERSON DO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1043401672
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9931255031
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090915000210
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KENERSON
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NEW ENGLAND, COLLEGE OF OSTEO MEDICINE
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	OSTEOPATHIC MANIPULATIVE MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	OSTEOPATHIC MANIPULATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	BE WELL MY FRIEND LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6406079342
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	12 SHUMAN AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	AUGUSTA
	Group Practice or individual's city
State	ME
	Group Practice or individual's state
Zip Code	043306020
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8552393556
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	200039
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAINE GENERAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y