Kenneth John Guidera, M.D.

Primary specialty

Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X

License

47329 Issued in MN

Practice address

2025 E River Pkwy
Minneapolis, MN 55414-3604

Phone

(612) 596-6187

Fax

(612) 339-7634

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• C3 Wellness, LLC

  • Multi-Specialty Clinic/Center
  • Kissimmee, FL
  • NPI 1811490287
  Medicare reassignment NPD

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301875200000",
    "number": "1922150697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 209036",
            "address_2": "SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753209036",
            "telephone_number": "813-281-8478",
            "fax_number": "813-281-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 E RIVER PKWY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143604",
            "telephone_number": "612-596-6187",
            "fax_number": "612-339-7634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUIDERA",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "MN",
            "license": "47329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158417100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922150697",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sixto Guiang III, M.D.
• Guidance Center LLC
• Guidance Home Care Inc.
• Guidance Home Health Care LLC
• Guided Pathway
• Guiding Lights Service LLC
• Claire Lee Guidinger, PH.D.
• Daniel James Guillaume, MD
• Mary Kathleen Guillen
• Sarah Abbott Guillet, L.P.

• Pediatric Orthopaedic Surgery Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatric Orthopaedic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.