NPIMap

Individual provider Active NPI

Kenneth Peter Walsh, MD

  • Vascular Surgery Physician
  • Hackensack, NJ
National Provider Identifier
1225458144
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
25MA1284700 Issued in NJ
Practice address
211 Essex Street
Suite 102
Hackensack, NJ 07601
Phone
(201) 487-8882
Fax
(201) 487-0943
NPI assigned
Apr 17, 2014
Last updated
Sep 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X MD-54007 IA
Vascular Surgery Physician 2086S0129X 25MA1284700 NJ Primary

Addresses

Primary practice location

211 Essex Street
Suite 102
Hackensack, NJ 07601

Mailing address

211 Essex Street
Suite 102
Hackensack, NJ 07601
Phone (201) 487-8882

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, IA, NJ3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20230331000293 GA Practitioner - Vascular Surgery 2668878893 Reassigns benefits to 1 organization
I20250206003200 IA Practitioner - Vascular Surgery 2668878893 Reassigns benefits to 2 organizations
I20260209002170 NJ Practitioner - Vascular Surgery 2668878893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Temple University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Iowa Mercy ClinicsGroup PAC ID 7810809076, 304 clinicians
Bergen Surgical Specialists,P.a.Group PAC ID 0244231215, 6 clinicians
Mason City Clinic PCGroup PAC ID 2860385572, 15 clinicians

Practice addresses (Care Compare)

1000 4TH St SW
Mason City, IA 50401-2800

211 Essex St
Suite 102
Hackensack, NJ 07601-3244
Phone (201) 487-8882

250 S Crescent Dr
Mason City, IA 50401-2926

635 E US Hwy 9
Mercyone Forest City Family Medicine
Forest City, IA 50436-1028
Phone (641) 585-2904

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.88 of 100Reported as group
Quality
94.45
Promoting interoperability
100
Improvement activities
40
Cost
85.15

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)41
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bergen Surgical Specialists, PA CurrentSince Feb 1, 2026 Accepting new patients
Mason City Clinic PC CurrentSince Jan 28, 2025 Accepting new patients
River City Vascular Specialists LLC CurrentSince Mar 7, 2023 Accepting new patients
North Iowa Mercy Clinics Current Accepting new patients
North Iowa Mercy Clinics Vascular Surgery CurrentSince Jan 27, 2025 Accepting new patients
North Iowa Mercy Clinics Current Accepting new patients
North Iowa Mercy Clinics CurrentSince Jan 27, 2025 Accepting new patients
Guardian Medical Services, LLC PastSince Dec 1, 2022 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

1920 Warm Springs Rd
Columbus, GA 31904
Phone (706) 984-7000

250 S Crescent Dr
Mason City, IA 50401
Phone (541) 422-6588

250 S Crescent Dr
Ste 200
Mason City, IA 50401
Phone (641) 494-5300

211 Essex St
Ste 102
Hackensack, NJ 07601
Phone (201) 487-8882

Organizations & group practices 9

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 6

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": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789603200000",
    "number": "1225458144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 ESSEX STREET",
            "address_2": "SUITE 102",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-487-8882",
            "fax_number": "201-487-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 ESSEX STREET",
            "address_2": "SUITE 102",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-487-8882",
            "fax_number": "201-487-0943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "KENNETH",
        "middle_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2026-09-17",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IA",
            "license": "MD-54007",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MA1284700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.