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KENNETH D ROOT PA-C
NPI 1053353946
Physician Assistant in Grand Rapids, MI

Active since June 12, 2006PECOS EnrolledAccepts Medicare Assignment
1179 E PARIS AVE SE STE 150, GRAND RAPIDS, MI 49546(616) 455-9450 Get Directions Write a Review

NPPES record last updated: May 14, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 14, 2026, Aug 15, 2017, Jan 18, 2016 (3 updates tracked since 2016).

About Kenneth D Root Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH D ROOT PA-C (NPI 1053353946) is an individual physician assistant in Grand Rapids, Michigan, licensed in Michigan (5601003447) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS and is a graduate of Other (2000).

NPPES Registry Identity

NPI1053353946
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameKENNETH D ROOTCredential: PA-C
Location Address1179 E PARIS AVE SE STE 150Grand Rapids, MI 49546-8373
Mailing Address1179 E Paris Ave Se Ste 150Grand Rapids, MI 49546-8373 · (616) 455-9450
Phone(616) 455-9450
Sole ProprietorNo
Medical School CMSOtherGraduated 2000
Enumeration DateJune 12, 2006
Last NPPES UpdateMay 14, 20263 updates tracked since enumeration
NPPES CertifiedMay 14, 2026
✔ NPI 1053353946 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in MI · 5601003447
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1179 E PARIS AVE SE STE 150, Grand Rapids, MI 49546
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kenneth D Root Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6406935535
PECOS Enrollment IDI20080430000862
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49546 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.74 typical visit price
range $54.34 – $166.68
Typical copayment $21.18 (range $13.58 – $41.67)
Most-billed visit code 99203
Established Patient
$68.07 typical visit price
range $17.09 – $135.40
Typical copayment $17.01 (range $4.27 – $33.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Root's NPI number?

The NPI number for Kenneth Root is 1053353946. It was assigned to this individual provider in the NPPES registry on June 12, 2006.

Where is Kenneth Root located?

Kenneth Root practices at 1179 E Paris Ave SE Ste 150, Grand Rapids, MI 49546. The listed phone number is (616) 455-9450.

What is Kenneth Root's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kenneth Root enrolled in Medicare?

Yes. Kenneth Root is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kenneth Root was last updated on May 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.