Kenneth Minkoff, MD

Primary specialty

Addiction Psychiatry PhysicianTaxonomy code 2084P0802X

License

39497 Issued in MA

Practice address

100 Powdermill Rd # 319
Acton, MA 01720-5932

Phone

(978) 502-1729

Fax

(415) 455-8016

NPI assigned

Sep 2, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Perelman School of Med at the University of Pennsylvania, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1033103247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 POWDERMILL RD # 319",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017205932",
            "telephone_number": "978-502-1729",
            "fax_number": "415-455-8016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 POWDERMILL RD # 319",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017205932",
            "telephone_number": "978-502-1729",
            "fax_number": "415-455-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINKOFF",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "MA",
            "license": "39497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2045915",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Middlesex Gastroenterolgy,P.C.
• Margaret Louise Mikkola, RD, LDN
• Grace Miller
• Eileen Kollmer Mills
• Bielda Milor
• Heather Mistry, PT, DPT
• Cody Mitchell
• Jennifer C Moccia
• Deborah-Ruth Mockrin, LICSW
• Vijay Modur, MD

• Addiction Psychiatry Physician in Acton, MA
• Providers in Acton, MA by specialty
• Addiction Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.