NPIMap

Individual provider Active NPI

Kenneth Alan Burckardt, M.D.

  • Anesthesiology Physician
  • Fort Wayne, IN
National Provider Identifier
1134446263
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
01074085A Issued in IN
Practice address
6435 W Jefferson Blvd # 434
Fort Wayne, IN 46804-6203
Phone
(260) 436-7875
Fax
(260) 432-9812
NPI assigned
Apr 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 01074085A IN Primary
Anesthesiology Physician 207L00000X 55448 KY

Addresses

Primary practice location

6435 W Jefferson Blvd # 434
Fort Wayne, IN 46804-6203

Mailing address

PO Box 843603
Dallas, TX 75284-3603
Phone (972) 233-1999

Other practice location 1

320 Whittington Pkwy
Suite 301
Louisville, KY 40222-4928
Phone (502) 625-5584

Other practice location 2

530 S Jackson St
Louisville, KY 40202-1675
Phone (502) 852-5851

Other identifiers 2

IdentifierTypeStateIssuer
7100458340MedicaidKY
201250880MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140825000042 IN Practitioner - Anesthesiology 0941428585 Reassigns benefits to 2 organizations
I20221220001995 KY Practitioner - Anesthesiology 0941428585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Louisville School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Anesthesia Services of Kentucky PLLCGroup PAC ID 0244590305, 351 clinicians

Practice addresses (Care Compare)

200 E Chestnut St
Louisville, KY 40202-1831
Phone (502) 629-8000

4000 Kresge Way
Louisville, KY 40207-4605
Phone (502) 897-8100

4960 Norton Healthcare Blvd
Louisville, KY 40241-2831
Phone (502) 446-8000

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130

Merit-based Incentive Payment System (MIPS)

Final score
67.76 of 100Reported as group
Quality
62.07
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01074085AINMDAnesthesiology Physician
55448KYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists of Fort Wayne PC Anesthesiology CurrentSince Sep 1, 2023 Accepting new patients
Northstar Anesthesia of Indiana LLC Anesthesiology CurrentSince Jan 1, 2023 Accepting new patients
Professional Anesthesia Services of Kentucky PLLC Anesthesiology CurrentSince Jun 10, 2024 Accepting new patients
One Anesthesia PLLC Anesthesiology Past Accepting new patients

Locations

1316 E 7th St
Auburn, IN 46706
Phone (260) 925-4600

24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237

6435 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 436-7875

10315 Dawsons Creek Blvd
Ste Ab
Fort Wayne, IN 46825
Phone (219) 436-7875

4023 Reas Ln
New Albany, IN 47150
Phone (502) 690-6425

1850 State St
New Albany, IN 47150
Phone (812) 944-7701

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

Organizations & group practices 4

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1134446263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843603",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752843603",
            "telephone_number": "972-233-1999",
            "fax_number": "972-233-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6435 W JEFFERSON BLVD # 434",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046203",
            "telephone_number": "260-436-7875",
            "fax_number": "260-432-9812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Whittington Pkwy",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402224928",
            "country_code": "US",
            "telephone_number": "502-625-5584",
            "fax_number": "502-426-2264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021675",
            "country_code": "US",
            "telephone_number": "502-852-5851",
            "fax_number": "502-852-3762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURCKARDT",
        "first_name": "KENNETH",
        "middle_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-29",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01074085A",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "55448",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100458340",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201250880",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.