NPIMap

Individual provider Active NPI

Kenneth Gwinn, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Shelby Township, MI
National Provider Identifier
1003910118
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
KG050974 Issued in MI
Practice address
48681 Hayes Rd
Shelby Township, MI 48315-4403
Phone
(586) 799-1212
Fax
(586) 799-1210
NPI assigned
Sep 11, 2006
Last updated
Dec 22, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X KG050974 MI Primary

Addresses

Primary practice location

48681 Hayes Rd
Shelby Township, MI 48315-4403

Mailing address

48681 Hayes Rd
Shelby Township, MI 48315-4403
Phone (586) 799-1212

Other identifiers 5

IdentifierTypeStateIssuer
258611OtherMIOMNICARE
000000009639OtherMICAPE HEALTH
C7134OtherMIMCARE HMO
0405011981OtherMIBCBS
131442OtherMIPREFERRED CHOICES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050126000238 MI Practitioner - Otolaryngology 3577513944 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Illinois Medical College, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kenneth L Gwinn MD PCGroup PAC ID 8325098791, 6 clinicians

Practice addresses (Care Compare)

15959 Hall Rd
Suite Ll104
Macomb, MI 48044-5364
Phone (586) 799-1212

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.54 of 100Reported as individual
Quality
64.08
Promoting interoperability
91
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
KG050974MIMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth L Gwinn MD PC Otolaryngology/Facial Plastic Surgery CurrentSince Jun 1, 1999 Accepting new patients

Locations

15959 Hall Rd
Ste LL104
Macomb, MI 48044
Phone (586) 799-1212

48681 Hayes Rd
Shelby Township, MI 48315
Phone (586) 726-7777

Interoperability endpoints

  • Direct secure messaging: kgwinn63369@direct.hfhs.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1003910118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48681 HAYES RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483154403",
            "telephone_number": "586-799-1212",
            "fax_number": "586-799-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48681 HAYES RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483154403",
            "telephone_number": "586-799-1212",
            "fax_number": "586-799-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWINN",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": "KG050974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNICARE",
            "identifier": "258611",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE HEALTH",
            "identifier": "000000009639",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE HMO",
            "identifier": "C7134",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0405011981",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "131442",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

Verify at the official NPI Registry.