KENNETH KISAMORE OD
NPI 1154364800
Optometrist in Rockville, MD
About Kenneth Kisamore Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENNETH KISAMORE OD (NPI 1154364800) is an individual optometrist in Rockville, Maryland, licensed in Maryland (TA0917) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, maintains a secondary practice location in Reston, and is a graduate of Pennsylvania State University College Of Medicine (1985).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kenneth Kisamore Od 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.
Medicare Billing Reassignments
4Medicare enrollment records show Kenneth Kisamore reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Rockville, MD 20850
- Reassigned Medicare billing, District of Columbia enrollment
- 49 clinicians in this Medicare group
Gaithersburg, MD 20878
- Reassigned Medicare billing, District of Columbia enrollment
- 187 clinicians in this Medicare group
Mc Lean, VA 22101
- Reassigned Medicare billing, Virginia enrollment
- 337 clinicians in this Medicare group
Sterling, VA 20166
- Reassigned Medicare billing, Virginia enrollment
- 37 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20850 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Kisamore's NPI number?
The NPI number for Kenneth Kisamore is 1154364800. It was assigned to this individual provider in the NPPES registry on June 13, 2006.
Where is Kenneth Kisamore located?
Kenneth Kisamore practices at 14929 Shady Grove Rd Unit K, Rockville, MD 20850. The listed phone number is (301) 424-1050.
What is Kenneth Kisamore's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Kenneth Kisamore enrolled in Medicare?
Yes. Kenneth Kisamore 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.
Which organizations bill Medicare for Kenneth Kisamore's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Kisamore reassigns Medicare benefits to 4 organizations: Rockville Optometry, LLC (Rockville, MD), Myeyedr Optometry Of Maryland, LLC (Gaithersburg, MD), Myeyedr Optometry Of Virginia, PLLC (Mc Lean, VA) and Dulles Optometry, LLC (Sterling, VA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenneth Kisamore's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kenneth Kisamore accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 9 other insurers list Kenneth Kisamore as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kenneth Kisamore was last updated on July 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.
# Kenneth Kisamore, OD · NPI 1154364800
Optometrist provider in Rockville, Maryland. Individual provider, active in the CMS NPPES registry since June 13, 2006.
## Identity
- **NPI:** 1154364800 (Entity type: Individual)
- **Enumerated:** June 13, 2006
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** TA0917 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 14929 SHADY GROVE RD UNIT K, Rockville, MD 20850-7728
- **Phone:** (301) 424-1050 · **Fax:** (301) 424-3184
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 4 organizations under Medicare reassignment (form CMS-855R): Rockville Optometry, LLC (NPI 1548325798, Rockville, MD); Myeyedr Optometry Of Maryland, LLC (NPI 1053200725, Gaithersburg, MD); Myeyedr Optometry Of Virginia, PLLC (NPI 1710643515, Mc Lean, VA); Dulles Optometry, LLC (NPI 1699956136, Sterling, VA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Pennsylvania State University College Of Medicine, class of 1985
## Record status
- **NPPES last updated:** July 24, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1154364800) · Data from the CMS NPPES public registry.