Paul R Kennedy, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003763 Issued in MI

Practice address

2117 E Grand River Ave
Lansing, MI 48912-3231

Phone

(517) 485-2213

Fax

(517) 485-2220

NPI assigned

Jan 25, 2007

Last updated

Jan 18, 2021By the provider in NPPES

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 MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bennett Optometry LLCGroup PAC ID 5193719367, 17 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: paul.kennedy.p1@direct.grophthalmology.nextgenshare.com
• Direct secure messaging: paulkennedy@direct.eyecare-partners.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bennett Optometry LLC

  dba Bennett Optometry

  • Optometrist
  • Ann Arbor, MI
  • NPI 1992792154
  Medicare reassignment Care Compare group
• Blue Sky Vision Eye Care, P.C

  dba Grand Rapids Ophthalmology

  • Ophthalmology Physician
  • Grand Rapids, MI
  • NPI 1801977202

  Optometrist

  Medicare reassignment NPD
• Blue Sky Vision Eye Care, PC

  dba Tukel Eye Center

  • Ophthalmology Physician
  • Dearborn, MI
  • NPI 1316675598
  NPD

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1013063114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 208177",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753208177",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 E GRAND RIVER AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489123231",
            "telephone_number": "517-485-2213",
            "fax_number": "517-485-2220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5857 West Saginaw Highway",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489172460",
            "country_code": "US",
            "telephone_number": "517-323-8221",
            "fax_number": "517-323-7976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PAUL",
        "middle_name": "R",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944801636",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mikayla Kempf, PA-C, ATC
• Grace P Kempter, DPT
• Ken Holmberg LLC
• Megan M Kendrick, LMSW
• Dana Beth Kennedy, NP-C
• Kenneth C. Ackley, D.D.S.
• Jeremiah Kenney, RN
• Ryan Kenney, M.D
• Chamara Love Kenno
• Anessa Kent-Johnson, LLMSW

• Optometrist in Lansing, MI
• Providers in Lansing, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.