Kenneth M Smith, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

19785 Issued in MN

Practice address

1805 Hennepin Ave N
Glencoe, MN 55336-1416

Phone

(320) 864-3121

Fax

(320) 864-7892

NPI assigned

Jun 6, 2007

Last updated

Feb 19, 2025By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Urology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Glencoe Regional Health ServicesGroup PAC ID 1759292980, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Glencoe Regional Health Hospital, Glencoe, MN, CCN 241355
• Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksmith585884@excellian.direct.allina.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Glencoe Regional Health Services

  • Critical Access Hospital
  • Glencoe, MN
  • NPI 1508885633
  Medicare reassignment Care Compare group NPD
• Group Health, Inc.

  dba HealthPartners Medical Group

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment NPD
• Glencoe Regional Health Services

  • Durable Medical Equipment & Medical Supplies
  • Glencoe, MN
  • NPI 1518074632
  NPD
• Group Health, Inc.

  dba HealthPartners Midway Residency Dental

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053
  NPD
• Glencoe Regional Health Services

  • Medicare Defined Swing Bed Hospital Unit
  • Glencoe, MN
  • NPI 1194832287
  NPD (past)

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

• Glencoe Regional Health Services

  • Critical Access Hospital
  • Glencoe, MN
  • NPI 1508885633
  Care Compare affiliation
• Ridgeview Medical Center

  • General Acute Care Hospital
  • Waconia, MN
  • NPI 1275608457
  Care Compare affiliation
• Ridgeview Medical Center

  • General Acute Care Hospital
  • Chaska, MN
  • NPI 1710748538
  Care Compare affiliation

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1982807350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121",
            "fax_number": "320-864-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121",
            "fax_number": "320-864-7892"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 Phalen Blvd - MS 51103C",
            "address_2": "HealthPartners Specialty Center 435",
            "address_purpose": "LOCATION",
            "city": "St. Paul",
            "state": "MN",
            "postal_code": "551305302",
            "country_code": "US",
            "telephone_number": "651-254-8500",
            "fax_number": "651-254-8504",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1025 Marsh St",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560014752",
            "country_code": "US",
            "telephone_number": "507-625-4031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "19785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith585884@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1805 Hennepin Ave N",
            "city": "Glencoe",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553361416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Linda Senst, BA
• Marty Sherman, LADC
• Shopko Stores Operating Co LLC (Shopko Pharmacy 732)
• Shopko Stores Operating Co LLC (Shopko Optical)
• Robin Sikkila, PHN
• Peter Thomas Smyth, MD
• Laurie Ann Snegosky, RN/PHN
• Kimberly Rose Sobiech, OTR/L
• Renata Solum
• Southwest Eye Care

• Urology Physician in Glencoe, MN
• Providers in Glencoe, MN by specialty
• Urology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.