Active NPI
Kenneth J Wilkens, MD
- Orthopaedic Trauma Physician
- Fountain Valley, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Trauma Physician
- License
- A80116
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| I28424 | Other | CA | UPIN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Practice addresses (Care Compare)
722 Baker St
Costa Mesa, CA 92626-4320
Phone (714) 557-6300
Hospital & facility affiliations
- Memorialcare Orange Coast Medical Center
- Memorialcare Saddleback Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles (2 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorialcare Medical Foundation | Current | Accepting new patients | |
| Acute Care Surgery Medical Group, Inc. | Current | 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
- 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.
-
- General Acute Care Hospital
- Fountain Valley, CA
- NPI 1497702575
Hospital
-
- General Acute Care Hospital
- Laguna Hills, CA
- NPI 1275576381
Hospital
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.