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KENNETH KISAMORE OD
NPI 1154364800
Optometrist in Rockville, MD

Active since June 13, 2006PECOS EnrolledAccepts Medicare Assignment
14929 SHADY GROVE RD UNIT K, ROCKVILLE, MD 20850(301) 424-1050(301) 424-3184 Get Directions Write a Review

NPPES record last updated: July 24, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 24, 2024, Dec 10, 2021 (2 updates tracked since 2021).

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

NPI1154364800
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameKENNETH KISAMORECredential: OD
Location Address14929 SHADY GROVE RD UNIT KRockville, MD 20850-7728
Mailing Address8614 Westwood Center Dr Fl 9Vienna, VA 22182-2442 · (703) 847-8899 · Fax (866) 795-4020
Phone(301) 424-1050
Fax(301) 424-3184
Sole ProprietorNo
Medical School CMSPennsylvania State University College Of MedicineGraduated 1985
Enumeration DateJune 13, 2006
Last NPPES UpdateJuly 24, 20242 updates tracked since enumeration
NPPES CertifiedJuly 24, 2024
✔ NPI 1154364800 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Licenses✔ Licensed in MD · TA0917✔ Licensed in VA · 0618001710
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
14929 SHADY GROVE RD UNIT K, Rockville, MD 20850
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Secondary Practice Location 1

Location 11841 Fountain DrReston, VA 20190-3326 · Phone (703) 264-2020 · Fax (703) 481-9474

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

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 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.

PECOS PAC ID4082717475
PECOS Enrollment IDI20070305000351
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.

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.

Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
15 services15 patients

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.

New Patient
$147.85 typical visit price
range $65.18 – $194.86
Typical copayment $36.96 (range $16.29 – $48.71)
Most-billed visit code 99204
Established Patient
$80.66 typical visit price
range $21.40 – $158.88
Typical copayment $20.16 (range $5.35 – $39.72)
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.

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.

ROCKVILLE OPTOMETRY, LLC
Optometrist
14929 SHADY GROVE RD UNIT K
ROCKVILLE, MD 20850
Montgomery County (301) 424-1050
DR. KIMOANH THAI O.D.
Optometrist
14929 SHADY GROVE RD UNIT K
ROCKVILLE, MD 20850
Montgomery County (301) 424-1050

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.

What insurance does Kenneth Kisamore accept?

Health plans from Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 2 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.