Kenneth Richard Phelps, PA-C
NPI 1669807210ActiveIndividual· Physician Assistant· Jacksonville, FL
Physician Assistant (PA-C) in Jacksonville, Florida, trained at At Still University, Arizona School of Dentistry & Oral Hlth (class of 2013). Medicare paid $24,832 for services to 181 patients in 2024. Medtronic, Inc. reported $23.63 in payments in 2024, mostly food and beverage.
Overview
| NPI | 1669807210 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | No |
| NPI issued | Sep 13, 2013 |
| Last updated in NPPES | Feb 26, 2021 |
| Certified by provider | Feb 26, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | PA9107403 | FL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (GA) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 181 |
|---|---|
| Services billed | 443 across 31 procedure codes |
| Paid by Medicare | $24,832 |
Education and affiliations
| Medical school | At Still University, Arizona School of Dentistry & Oral Hlth |
|---|---|
| Graduation year | 2013 |
| Medicare specialty | Physician Assistant |
Medical group
- Summit Radiology Services P CJasper, GA · 70 clinicians
Hospital affiliations
- Northside HospitalAtlanta, GA
- Piedmont Henry HospitalStockbridge, GA
Industry payments (Open Payments)
- 2024$23.63 · 1 payment from 1 company
Top paying companies in 2024
| Company | Amount | Payments |
|---|---|---|
| Medtronic, Inc. | $23.63 | 1 |
What the 2024 payments were for
- Food and Beverage$23.63 · 1 payment
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 895 physician assistants in Jacksonville · All physician assistants in Florida