Individual provider Active NPI

Barbara C Kennedy, MD

  • Pediatrics Physician
  • South Burlington, VT
National Provider Identifier
1063478501
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
042-0008987 Issued in VT
Practice address
51 Timber LN
South Burlington, VT 05403-5201
Phone
(802) 864-0521
Fax
(802) 864-6475
NPI assigned
Apr 24, 2006
Last updated
Mar 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 042-0008987 VT Primary

Addresses

Primary practice location

51 Timber LN
South Burlington, VT 05403-5201

Mailing address

66 Knight LN Ste 10
Williston, VT 05495-9308
Phone (802) 872-4343

Other identifiers 1

IdentifierTypeStateIssuer
OVN0967MedicaidVT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address drkennedy@pchpmd.medentdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
042-0008987VTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Health Partners Pediatrics CurrentSince Dec 6, 2022 Accepting new patients
Primary Care Health Partners - New York LLP Pediatrics PastSince Jul 2, 2023 Accepting new patients

Locations

51 Timber Ln
South Burlington, VT 05403
Phone (802) 864-0521

66 Knight Ln
Ste 10
Williston, VT 05495
Phone (802) 872-4327

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1063478501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 KNIGHT LN STE 10",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054959308",
            "telephone_number": "802-872-4343",
            "fax_number": "802-288-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054035201",
            "telephone_number": "802-864-0521",
            "fax_number": "802-864-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "BARBARA",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-24",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "042-0008987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN0967",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drkennedy@pchpmd.medentdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "51 Timber Ln",
            "city": "South Burlington",
            "state": "VT",
            "country_code": "US",
            "postal_code": "054035201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.