NPIMap

Organization Active NPI

Kenneth L Gwinn MD PC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Shelby Township, MI
National Provider Identifier
1629163217
Registry record updated Oct 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
KG050974 Issued in MI
Legal business name
KENNETH L GWINN MD PC
Practice address
48681 Hayes Rd
Shelby Township, MI 48315
Phone
(586) 799-1212
NPI assigned
Oct 3, 2006
Last updated
Oct 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2008

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

Authorized official

Name
Dr. Kenneth L Gwinn, MDNPI 1003910118
Title
President
Phone
(586) 799-1212

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X KG050974 MI Primary

Addresses

Primary practice location

48681 Hayes Rd
Shelby Township, MI 48315

Mailing address

1976 Momentum PL
Chicago, IL 60689-5319
Phone (586) 799-1212

Other identifiers 7

IdentifierTypeStateIssuer
258611OtherMIOMNICARE
102795880OtherMIGREAT LAKES HEALTH PLAN
12795880MedicaidMI
000000009639OtherMICAPE HEALTH
131442OtherMIPREFERRED CHOICES
C7134OtherMIMCARE HMO
0405011981OtherMIBCBS OF MICHIGAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050125000196 MI Part B Supplier - Clinic/Group Practice 8325098791 Receives reassigned benefits from 10 practitioners
Practice locations: Macomb, MI

National Provider Directory

National Provider Directory

Locations

1976 Momentum Pl
Chicago, IL 60689

15959 Hall Rd
Ste LL104
Macomb, MI 48044
Phone (586) 799-1212

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222905600000",
    "number": "1629163217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1976 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895319",
            "telephone_number": "586-799-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48681 HAYES RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "48315",
            "telephone_number": "586-799-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH L GWINN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-10-02",
        "status": "A",
        "authorized_official_last_name": "GWINN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-799-1212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": "KG050974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNICARE",
            "identifier": "258611",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "102795880",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12795880",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE HEALTH",
            "identifier": "000000009639",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "131442",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE HMO",
            "identifier": "C7134",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "0405011981",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; 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.