NPIMap

Organization Active NPI

Kenneth D Warren DPM PLLC

  • Podiatric Clinic/Center
  • Kennebunk, ME
National Provider Identifier
1437402013
Registry record updated Sep 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
License
1084 Issued in ME
Legal business name
KENNETH D WARREN DPM PLLC
Practice address
2 Berry CT
Kennebunk, ME 04043-6812
Phone
(207) 985-9888
Fax
(207) 985-3488
NPI assigned
Oct 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2013

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

Authorized official

Name
Dr. Kenneth Warren Jr., DPMNPI 1689854382
Title
Sole Member
Phone
(216) 577-7754

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 1880 TX
Podiatric Clinic/Center 261QP1100X 1084 ME Primary

Addresses

Primary practice location

2 Berry CT
Kennebunk, ME 04043-6812

Mailing address

2 Berry CT
Kennebunk, ME 04043-6812
Phone (207) 985-9888

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130213000015 ME Part B Supplier - Clinic/Group Practice 6901050392 Receives reassigned benefits from 1 practitioner
Practice locations: Kennebunk, ME

National Provider Directory

National Provider Directory

Locations

2 Berry Ct
Kennebunk, ME 04043
Phone (207) 985-8460

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378425600000",
    "number": "1437402013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 BERRY CT",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040436812",
            "telephone_number": "207-985-9888",
            "fax_number": "207-985-3488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BERRY CT",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040436812",
            "telephone_number": "207-985-9888",
            "fax_number": "207-985-3488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH D WARREN DPM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-19",
        "last_updated": "2013-09-06",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "216-577-7754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "1880",
            "primary": false
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "ME",
            "license": "1084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennebunk, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.