Kenneth Gerdes , LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

117124 Issued in MO

Legal business name

KENNETH GERDES , LLC

Practice address

11155 Dunn Rd
Suite 211N
Saint Louis, MO 63136-6150

Phone

(314) 432-2580

Fax

(314) 991-8960

NPI assigned

Jun 9, 2006

Last updated

Dec 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jacki Jordan

Title

Billing Manager

Phone

(314) 432-2580

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

Enrollment records 2

Locations

Practitioners 1

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.

• Kenneth L Gerdes, M.D.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1720020100

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1679514095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1209",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630430209",
            "telephone_number": "314-432-2580",
            "fax_number": "314-991-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11155 DUNN RD",
            "address_2": "SUITE 211N",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366150",
            "telephone_number": "314-432-2580",
            "fax_number": "314-991-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH GERDES , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JACKI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "314-432-2580",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "117124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR GROUP PROV#",
            "identifier": "DE2084",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500745609",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Kennedy, PHARMD
• Danielle Marie Kenner, PNP
• Kennerly Dental Group, Inc.
• Kenneth B. Scroggins, D.M.D., LLC
• Kenneth E Rigden D.D.S.,P.C.
• Jennifer M Kennett, RN
• Christina Kenney
• Claire Therese Kenney, MD, PHD
• Isabella Maria Kenney, MSW, LCSW
• Kaitlin G Kenney, MD

• Specialist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.