Kenneth George Handy, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036068557 Issued in IL

Practice address

400 North Wall St
Ste 504
Kankakee, IL 60901-2965

Phone

(815) 932-4021

Fax

(815) 932-7270

NPI assigned

Aug 31, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261094400000",
    "number": "1003927013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 NORTH WALL ST",
            "address_2": "STE 504",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012965",
            "telephone_number": "815-932-4021",
            "fax_number": "815-932-7270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NORTH WALL ST",
            "address_2": "STE 504",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012965",
            "telephone_number": "815-932-4021",
            "fax_number": "815-932-7270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANDY",
        "first_name": "KENNETH",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036068557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036068557",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kendra G Hansen, ANP-BC
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• Brenique Harris
• George Aaron Harris II
• La'Shay Harris

• Family Medicine Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.