Kenneth L. Serra, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

52377 Issued in AZ

Practice address

11995 Singletree LN Ste 500
Eden Prairie, MN 55344-5349

Phone

(952) 595-1301

Fax

(612) 294-4903

NPI assigned

Feb 27, 2006

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Diagnostic Radiology

Education

University of Colorado School of Medicine, Denver, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Valley Radiology Associates PLLCGroup PAC ID 2062916083, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chandler Regional Medical Center Hospital, Chandler, AZ, CCN 030036
• Mercy Gilbert Medical Center Hospital, Gilbert, AZ, CCN 030119

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• East Valley Radiology Associates PLLC

  • Diagnostic Radiology Physician
  • Chandler, AZ
  • NPI 1518853928
  Medicare reassignment Care Compare group NPD
• Virtual Radiologic Professionals, LLC

  • Diagnostic Radiology Physician
  • Edina, MN
  • NPI 1932342029

  AZ

  Medicare reassignment
• Flatirons Radiology, LLC

  • Body Imaging Physician
  • Denver, CO
  • NPI 1700911393

  Diagnostic Radiology

  NPD (past)
• Radiology Associates of San Luis Obispo

  • Specialist
  • Pismo Beach, CA
  • NPI 1417182510
  NPD (past)
• Santa Cruz Medical Clinic, Inc

  • Family Medicine Physician
  • Santa Cruz, CA
  • NPI 1588775308
  NPD (past)

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

• Dignity Community Care

  • General Acute Care Hospital
  • Chandler, AZ
  • NPI 1700910189
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Gilbert, AZ
  • NPI 1992735088
  Care Compare affiliation

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1568438810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRA",
        "first_name": "KENNETH",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "52377",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "DR-46751",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Kay Seifert-Pederson, RPH
• Leah Marie-Cox Seifert, SLP
• Larrissa Serafin, MSW, LGSW
• Katie L Seremet, NP
• Serene Housing LLC
• Myranda Dawn Shafer
• Sadichhya Shakya
• Noor Hisham Shalabi
• Gauri Sharma, PHARMD. BCPS
• Sharockman Counseling

• Diagnostic Radiology Physician in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Diagnostic Radiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.