KEVIN JOHN WICKENHEISER (M.D.) – Emergency Medicine Physician, NPI 1043506520

KEVIN JOHN WICKENHEISER (M.D.) is a healthcare provider. based in Detroit, Michigan. specializing in EMERGENCY MEDICINE. They hold the professional credentials M.D.. They hold a License No. 4301098989 (MI). The NPI Number for KEVIN JOHN WICKENHEISER (M.D.) is 1043506520

Main info

Male
15 Years Of Experience
Accepts Medicare Assignment
Name
KEVIN JOHN WICKENHEISER (M.D.)
NPI
1043506520
Phone
Not provided
Address
2799 W GRAND BLVD
Enumeration Date
23 June 2011
Last Update Date
23 June 2011

Doctor Profile

Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4192513232
Graduation Year
2011 (15 years ago)
PAC ID
7214160001
Group Practice PAC ID
9436475795
Professional Enrollment ID
I20160831001486
Address ID
OH436082603TO2213XSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness75
Years active:14State licenses:1Digital endpointsOther names

3,166 EMERGENCY MEDICINE in MI

Provider Addresses for KEVIN JOHN WICKENHEISER (M.D.)

  • 2799 W GRAND BLVD

    DETROIT, MI 482022608

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $23.

Total Amount is formed as General ($23) + Research ($0) + Ownership ($0) = $23.

Last reported payment date: 2023-06-13 • Largest payer in this snapshot: ABBVIE INC. ($23).

Total Amount

$23

General + Research + Ownership

Payments

1

Total payment records

General Amount

$23

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-06-13

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$23
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-08-31

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160831001486IEmergency MedicineOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making217195$0
99284Emergency department visit with moderate level of medical decision making101100$0
99283Emergency department visit with low level of medical decision making4137$0
99291Critical care, first 30-74 minutes1919$0
View full utilization report →

Insurance plans in this area (ZIP 48202)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9436475795View full group profile

Reviews

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Frequently asked questions

What is the registry number for KEVIN JOHN WICKENHEISER (M.D.)?
The registry entry for KEVIN JOHN WICKENHEISER (M.D.) shows NPI 1043506520.
Is KEVIN JOHN WICKENHEISER (M.D.)'s NPI status active today?
Active status means KEVIN JOHN WICKENHEISER (M.D.)'s NPI record is not deactivated in the public file.
What does the directory say KEVIN JOHN WICKENHEISER (M.D.) does?
Insurance directories may phrase it differently, but here KEVIN JOHN WICKENHEISER (M.D.) maps to Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is KEVIN JOHN WICKENHEISER (M.D.) tied to Detroit, Michigan?
If you are local to Detroit, Michigan, KEVIN JOHN WICKENHEISER (M.D.) may be relevant to your search.
Why is information missing for KEVIN JOHN WICKENHEISER (M.D.)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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