NPIMap

Individual provider Active NPI

Matthew P Kenny, PA-C

  • Physician Assistant
  • Midland, MI
National Provider Identifier
1043232689
Registry record updated Oct 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004770 Issued in MI
Practice address
728 W Wackerly St Ste 100
Midland, MI 48640-4724
Phone
(989) 839-8824
Fax
(989) 835-3398
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004770 MI Primary

Addresses

Primary practice location

728 W Wackerly St Ste 100
Midland, MI 48640-4724

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956

Other identifiers 2

IdentifierTypeStateIssuer
E66019098OtherMIMEDICARE PTAN
Z96017107OtherMIMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060817000443 MI Practitioner - Physician Assistant 5092718726 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians
Curtis S Young MD PLCGroup PAC ID 1153413125, 2 clinicians

Practice addresses (Care Compare)

4500 Campus Ridge Dr
Midland, MI 48640-6123
Phone (989) 837-9250

728 W Wackerly St
Midland, MI 48640-4724
Phone (989) 839-8824

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004770MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center, Inc CurrentSince Aug 1, 2021 Accepting new patients
Covenant Medical Center, Inc CurrentSince Aug 1, 2021 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Sep 9, 2025 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Sep 9, 2025 Accepting new patients
Emergency Care Specialists PC Past Accepting new patients
Advanced Orthopedic Specialists PC Past Accepting new patients

Locations

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

728 W Wackerly St
Ste 100
Midland, MI 48640
Phone (989) 631-8300

4851 E Pickard St
Ste 1100
Mt Pleasant, MI 48858
Phone (989) 546-2170

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

Interoperability endpoints

  • Direct secure messaging: matthewkenny@csymdplc.allscriptsdirect.net
  • Direct secure messaging: mkenny105567@direct.covenanthealthcare.com

Organizations & group practices 8

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761350400000",
    "number": "1043232689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "844-832-1956",
            "fax_number": "989-633-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 W WACKERLY ST STE 100",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486404724",
            "telephone_number": "989-839-8824",
            "fax_number": "989-835-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNY",
        "first_name": "MATTHEW",
        "middle_name": "P",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2025-10-25",
        "certification_date": "2025-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "E66019098",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z96017107",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.