Kenneth Carl James Fitzgerald III, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

024187 Issued in LA

Practice address

2551 Greenwood Rd Ste 410
Shreveport, LA 71103-3989

Phone

(318) 621-2929

NPI assigned

Oct 10, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

Specialty

Internal Medicine

Education

Louisiana State University School of Medicine in Shreveport, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

WK Tri-State Medical ClinicGroup PAC ID 0143225128, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elara Caring Home health agency, Mansfield, LA, CCN 197161
• Louisiana Homecare Home health agency, Mansfield, LA, CCN 197052
• Elara Caring Home health agency, Bossier City, LA, CCN 197226
• Centerwell Home Health Home health agency, Coushatta, LA, CCN 197334
• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
• Desoto Regional Health System Hospital, Mansfield, LA, CCN 190118

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3361/brand/1/csg/1/fhir/r4
• Direct secure messaging: kennethfitzgerald@wlmd.allscriptsdirect.net

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.

• WK Tri-State Medical Clinic

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1225082746
  Medicare reassignment Care Compare group NPD
• Internal Medicine and Pediatrics Associates LLC

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1205915121
  NPD (past)
• Rajendra T Gandhi, MD, LLC

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1053595769
  NPD (past)
• WK North Pulmonary & Critical Care

  • Critical Care Medicine (Internal Medicine) Physician
  • Shreveport, LA
  • NPI 1265529648
  NPD (past)

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

• Desoto Hospital Association

  • General Acute Care Hospital
  • Mansfield, LA
  • NPI 1467455154
  Care Compare affiliation
• Health Care Visions III, Inc.

  • Home Health Agency
  • Bossier City, LA
  • NPI 1053485961
  Care Compare affiliation
• Louisiana Home Healthcare Partners, LLC

  • Home Health Agency
  • Mansfield, LA
  • NPI 1417981853
  Care Compare affiliation
• Louisiana Homecare of Northwest Louisiana, LLC

  • Home Health Agency
  • Mansfield, LA
  • NPI 1285681171
  Care Compare affiliation
• Synergy Home Care Northwestern Region Inc

  • Home Health Agency
  • Coushatta, LA
  • NPI 1982696217
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1811985245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD STE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033989",
            "telephone_number": "318-621-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD STE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033989",
            "telephone_number": "318-621-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "KENNETH",
        "middle_name": "CARL JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "024187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fit for Life Ministries Inc
• Joseph Fitz-Gerald
• Mary Jo Fitz-Gerald, M.D.
• Carolyn Fitzgerald
• Julia Fitzgerald
• Five Star Elite Home Health LLC
• Five Star Elite Transportation Services LLC
• Larry Lucas Flake, MD
• Carolyn Flanagan Ruffin
• Sarah Thorne Flanagan, MD

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.

Verify at the official NPI Registry.