Kenneth Wilson Backstrand, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

ME50622 Issued in FL

Practice address

2721 Del Prado Blvd S
Cape Coral, FL 33904-5781

Phone

(239) 242-8010

Fax

(239) 242-8020

NPI assigned

Oct 11, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Moonlight Anesthesia, P.L.

  • Anesthesiology Physician
  • Fort Myers, FL
  • NPI 1033419791
  Medicare reassignment NPD
• PRP Centers of Florida LLC

  • Ambulatory Surgical Clinic/Center
  • Fort Myers, FL
  • NPI 1265882096
  NPD (past)

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520467200000",
    "number": "1114915477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 BARKLEY CIR STE 3",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074518",
            "telephone_number": "239-226-0910",
            "fax_number": "239-226-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2721 DEL PRADO BLVD S",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339045781",
            "telephone_number": "239-242-8010",
            "fax_number": "239-242-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKSTRAND",
        "first_name": "KENNETH",
        "middle_name": "WILSON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME0050622",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME50622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046206300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Babylove Midwifery Services
• Sakeena Baccas, PA-C
• Katlin Bacha
• Back Door, LLC
• Back in Motion Cape Coral LLC
• Rey Christian Imperial Badilla, PT
• Victoria Badillo
• Adrialys Baez Marrero, RBT-20-135334
• Julio Cesar Baez
• Yvonne Bailey, ADMINISTRATOR

• Pain Medicine (Anesthesiology) Physician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Pain Medicine (Anesthesiology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.