NPIMap

Individual provider Active NPI

Kandice Renee Beenken, D.O.

  • Orthopaedic Surgery Physician
  • San Diego, CA
National Provider Identifier
1982991501
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
20A15340 Issued in CA
Practice address
3750 Convoy St Ste 201
San Diego, CA 92111-3770
Phone
(858) 278-8031
Fax
(858) 278-1708
NPI assigned
Jul 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 5101019407 MI
Orthopaedic Surgery Physician 207X00000X DO2030 NV
Orthopaedic Surgery Physician 207X00000X 20A15340 CA Primary

Addresses

Primary practice location

3750 Convoy St Ste 201
San Diego, CA 92111-3770

Mailing address

3750 Convoy St Ste 201
San Diego, CA 92111-3770
Phone (858) 278-8031

Other practice location 1

2800 E Desert Inn Rd Ste 100
Las Vegas, NV 89121-3609
Phone (702) 731-1616

Other identifiers 4

IdentifierTypeStateIssuer
20A15340OtherCACA MEDICAL LICENSE
5101019407OtherMIMEDICAL LICENSE NUMBER
DO2030OtherNVNV MEDICAL LICENSE
1982991501MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170829004039 CA Practitioner - Orthopedic Surgery 2961795679 Reassigns benefits to 2 organizations
I20181227000276 MN Practitioner - Orthopedic Surgery 2961795679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2011
Medicare assignment
May accept Medicare assignment
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

1101 9TH St N
Virginia, MN 55792-2329
Phone (218) 741-0150

1600 Miller Trunk Hwy
Duluth, MN 55811-5640
Phone (218) 786-5360

Hospital & facility affiliations

  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Essentia Health Virginia Hospital, Virginia, MN, CCN 240084
  • Essentia Health Moose Lake Hospital, Moose Lake, MN, CCN 241350

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement23
Knee replacement20
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A15340CAMDOrthopaedic Surgery Physician
5101019407MIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency and Acute Care Medical Corporation CurrentSince Jul 31, 2017 Accepting new patients
The Duluth Clinic, LTD CurrentSince Jan 7, 2019 Accepting new patients
Jeffrey M. Smith, M.D., Inc. CurrentSince Aug 26, 2017 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jan 7, 2019 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
St Marys Medical Center Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

3750 Convoy St
Ste 201
San Diego, CA 92111
Phone (858) 278-8031

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

Interoperability endpoints

  • Direct secure messaging: kbeenken292628@direct.hfhs.org

Organizations & group practices 8

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 7

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": "1309737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1982991501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 CONVOY ST STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113770",
            "telephone_number": "858-278-8031",
            "fax_number": "858-278-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 CONVOY ST STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113770",
            "telephone_number": "858-278-8031",
            "fax_number": "858-278-1708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 E Desert Inn Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891213609",
            "country_code": "US",
            "telephone_number": "702-731-1616",
            "fax_number": "702-731-0741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEENKEN",
        "first_name": "KANDICE",
        "middle_name": "RENEE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101019407",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NV",
            "license": "DO2030",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "20A15340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "20A15340",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "5101019407",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV MEDICAL LICENSE",
            "identifier": "DO2030",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982991501",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.