Individual provider Active NPI

Kenneth D. Wilgers, M.D.

  • Family Medicine Physician
  • Beaumont, TX
National Provider Identifier
1275506206
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K7946 Issued in TX
Practice address
3129 College St
Suite 200
Beaumont, TX 77701-4660
Phone
(409) 832-8600
Fax
(409) 832-8601
NPI assigned
Feb 9, 2006
Last updated
Aug 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Basic Emergency Medical Technician 146N00000X K7946 TX
Family Medicine Physician 207Q00000X K7946 TX Primary

Addresses

Primary practice location

3129 College St
Suite 200
Beaumont, TX 77701-4660

Mailing address

3129 College St Ste 200
Beaumont, TX 77701-4682
Phone (409) 832-8600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20071030000608 TX Practitioner - Family Practice 0648367110 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical Branch at Galveston, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kenneth D Wilgers M.D. PAGroup PAC ID 7810084381, 2 clinicians

Practice addresses (Care Compare)

3129 College St
Suite 200
Beaumont, TX 77701-4682
Phone (409) 832-8600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K7946TXMDFamily Medicine Physician
H1169TXMDMaternal & Fetal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth D Wilgers M.D. PA Family Medicine CurrentSince Aug 1, 2007 Accepting new patients
Preventive Medicine of Southeast Texas, LLP Family Medicine Past Accepting new patients
Southeast Emergency Physician Associates, P.a. Past Accepting new patients
Anew Wellness, LLC Family Medicine PastSince Jul 23, 2018 Accepting new patients
Diagnostic Group of Southeast Texas LLC PastSince Aug 1, 2007 Accepting new patients

Locations

3129 College St
Ste 200
Beaumont, TX 77701
Phone (409) 832-8600

Organizations & group practices 5

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 2

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1275506206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3129 COLLEGE ST STE 200",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014682",
            "telephone_number": "409-832-8600",
            "fax_number": "409-832-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3129 COLLEGE ST",
            "address_2": "SUITE 200",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014660",
            "telephone_number": "409-832-8600",
            "fax_number": "409-832-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILGERS",
        "first_name": "KENNETH",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "TX",
            "license": "K7946",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K7946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.