DR. KENNETH MICHAEL KINGDON (MD) – Family Medicine Physician, NPI 1114067196
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,232 EMERGENCY MEDICINE in FL
Provider Addresses for DR. KENNETH MICHAEL KINGDON (MD)
21602 GRANADA HL
SAN ANTONIO, TX 782561673
Phone: (619) 300-2289
Type: Mailing
3601 SW 160TH AVE
SUITE 250
MIRAMAR, FL 330276308
Phone: (877) 866-7123
Fax: (855) 855-2792
Type: Location
PO BOX 577
BREWSTER, WA 988120577
Phone: (509) 689-2517
Fax: (509) 689-2086
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2024-05-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20121213000319 | I | Family Practice | TX | TBD |
| I20240522003150 | I | Emergency Medicine | WA | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 20 | 19 | $0 |
| 99285 | Emergency department visit with high level of medical decision making | 12 | 12 | $0 |
Insurance plans in this area (ZIP 78256)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | TN | |
| Internal Medicine, Infectious Disease | PA | |
| Internal Medicine | WA | |
| Diagnostic Radiology | OR | |
| Internal Medicine | OR | |
| O P H T H A L M O L O G Y | IA | |
| - | OR | |
| Nurse Practitioner | WA | |
| Nurse Practitioner | WA | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology) | CA |
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