Kenneth C Starks, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

65750 Issued in MN

Practice address

2450 Riverside Ave
Minneapolis, MN 55454-1450

Phone

(612) 672-6000

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

No

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 AK

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

Specialty

Internal Medicine

Education

University of Minnesota Medical School, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gold Star Longevity and Wellness LLCGroup PAC ID 3173863388, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.starks.1@19690.direct.athenahealth.com

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.

• Gold Star Longevity & Wellness LLC

  • Family Medicine Physician
  • Fairbanks, AK
  • NPI 1427532613
  Medicare reassignment Care Compare group
• Northern Hospital Associates LLC

  • Hospitalist Physician
  • Fairbanks, AK
  • NPI 1538204474
  NPD (past) Authorized official
• Tanana Valley Medical Surgical Group Inc

  dba Tanana Valley Clinic

  • Clinic/Center
  • Fairbanks, AK
  • NPI 1184691743
  NPD

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

• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1487799110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 OLD STEESE HWY",
            "address_2": "PMB 314",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013131",
            "telephone_number": "907-458-5178",
            "fax_number": "907-458-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 Lathrop St",
            "address_2": "Suite 121",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015937",
            "country_code": "US",
            "telephone_number": "907-458-5178",
            "fax_number": "907-458-5180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STARKS",
        "first_name": "KENNETH",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "3297",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "65750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007641",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randall P Stark, M.D.
• Samantha Jean Starke, PT
• Colleen Starkey
• Christy Lynn Starks, OTR/L
• Jamie Leigh Starks, M.D.
• Rayne Starks
• Starlight Autism Center LLC
• Starlight Home Services
• Leona D Starnes
• Katie Starns

• Internal Medicine Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.