Individual provider Active NPI

Kenneth K Maslonka, M.D.

  • Pediatric Critical Care Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1639170418
Registry record updated Jan 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
36031 Issued in MN
Practice address
2530 Chicago Ave Ste 400
Minneapolis, MN 55404-4387
Phone
(612) 813-3300
Fax
(612) 813-3349
NPI assigned
Aug 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 36031 MN Primary

Addresses

Primary practice location

2530 Chicago Ave Ste 400
Minneapolis, MN 55404-4387

Mailing address

2530 Chicago Ave Ste 400
Minneapolis, MN 55404-4387
Phone (612) 813-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050601000732 MN Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 0547236663 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pediatric Medicine
Education
Creighton University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Children's Respiratory and Critical Care Specialists PAGroup PAC ID 8022084235, 24 clinicians

Practice addresses (Care Compare)

2530 Chicago Ave
Suite 400
Minneapolis, MN 55404-4387
Phone (612) 813-3300

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince Apr 1, 2020 Accepting new patients
The Duluth Clinic, LTD CurrentSince May 27, 2013 Accepting new patients
Children's Respiratory & Critical Care Specialists. P.a. CurrentSince Dec 10, 2012 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Gillette Children's Specialty Healthcare CurrentSince Jan 20, 2018 Accepting new patients
Gillette Children's Specialty Healthcare CurrentSince Jan 20, 2018 Accepting new patients
The Duluth Clinic, LTD. CurrentSince May 27, 2013 Accepting new patients
North Memorial Health Care Current Accepting new patients
Childrens Health Care Past Accepting new patients
Gillette Children's Specialty Healthcare PastSince Dec 10, 2012 Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

2530 Chicago Ave
Ste 400
Minneapolis, MN 55404
Phone (612) 813-3300

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1639170418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044387",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044387",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASLONKA",
        "first_name": "KENNETH",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MN",
            "license": "36031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.