Individual provider Active NPI

Kenneth J Wilkens, MD

  • Orthopaedic Trauma Physician
  • Fountain Valley, CA
National Provider Identifier
1679519649
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Trauma PhysicianTaxonomy code 207XX0801X
License
A80116 Issued in CA
Practice address
17360 Brookhurst St.
Fountain Valley, CA 92708
Phone
(877) 844-0012
Fax
(714) 665-4680
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Trauma Physician 207XX0801X A80116 CA Primary

Addresses

Primary practice location

17360 Brookhurst St.
Fountain Valley, CA 92708

Mailing address

17360 Brookhurst St.
Attn: Administration
Fountain Valley, CA 92708
Phone (877) 844-0012

Other identifiers 1

IdentifierTypeStateIssuer
I28424OtherCAUPIN

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050505001254 CA Practitioner - Orthopedic Surgery 9335189687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorialcare Medical Foundation 555 clinicians

Practice addresses (Care Compare)

722 Baker St
Costa Mesa, CA 92626-4320
Phone (714) 557-6300

Hospital & facility affiliations

  • Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678
  • Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10

National Provider Directory

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

Practice roles (2 of 3)

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation CurrentSince Oct 1, 2024 Accepting new patients
Acute Care Surgery Medical Group, Inc. CurrentSince Dec 15, 2022 Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

414 G St
Ste 120
Marysville, CA 95901
Phone (530) 749-2110

726 4th St
Marysville, CA 95901
Phone (530) 491-9491

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

1800 Spring Ridge Dr
Susanville, CA 96130
Phone (530) 252-2225

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kenneth.wilkens.p17@direct.newportmed.nextgenshare.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1679519649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST.",
            "address_2": "ATTN: ADMINISTRATION",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "92708",
            "telephone_number": "877-844-0012",
            "fax_number": "714-665-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST.",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "92708",
            "telephone_number": "877-844-0012",
            "fax_number": "714-665-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKENS",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "CA",
            "license": "A80116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "I28424",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.