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KENETTE ST-GOURDIN MD
NPI 1619506557
Internal Medicine in Marietta, GA

Active since April 03, 2020PECOS EnrolledAccepts Medicare Assignment
631 CAMPBELL HILL ST NW STE 200, MARIETTA, GA 30060(770) 727-4130(770) 800-1334 Get Directions Write a Review

NPPES record last updated: December 4, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 4, 2024, Mar 7, 2024, Apr 3, 2020 (3 updates tracked since 2020).

About Kenette St-gourdin Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENETTE ST-GOURDIN MD (NPI 1619506557) is an individual internal medicine provider in Marietta, Georgia, licensed in Georgia (96398) and active in the NPI registry since April 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1619506557
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameKENETTE ST-GOURDINCredential: MD
Location Address631 CAMPBELL HILL ST NW STE 200Marietta, GA 30060-1390
Mailing Address631 Campbell Hill St Nw Ste 200Marietta, GA 30060-1390 · (314) 448-3791 · Fax (636) 996-7658
Phone(770) 727-4130
Fax(770) 800-1334
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateApril 3, 2020
Last NPPES UpdateDecember 4, 20243 updates tracked since enumeration
NPPES CertifiedDecember 4, 2024
✔ NPI 1619506557 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in GA · 96398
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedHospitalistTaxonomy 208M00000X · License 2023049186 (MO)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
631 CAMPBELL HILL ST NW STE 200, Marietta, GA 30060
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kenette St-gourdin Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1153768072
PECOS Enrollment IDI20250213001292
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
115 services114 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
102 services101 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$130.64 typical visit price
range $56.84 – $172.43
Typical copayment $32.66 (range $14.21 – $43.10)
Most-billed visit code 99204
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EPITOME PRIMARY CARE
Internal Medicine
631 CAMPBELL HILL ST NW STE 200
MARIETTA, GA 30060
Cobb County (770) 727-6124
WINDSOR PAMPHILE MD
Internal Medicine
631 CAMPBELL HILL ST NW STE 200
MARIETTA, GA 30060
Cobb County (912) 695-6090

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenette St-gourdin's NPI number?

The NPI number for Kenette St-gourdin is 1619506557. It was assigned to this individual provider in the NPPES registry on April 3, 2020.

Where is Kenette St-gourdin located?

Kenette St-gourdin practices at 631 Campbell Hill St NW Ste 200, Marietta, GA 30060. The listed phone number is (770) 727-4130.

What is Kenette St-gourdin's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kenette St-gourdin enrolled in Medicare?

Yes. Kenette St-gourdin is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kenette St-gourdin was last updated on December 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.