Gregory Stephen Kaczenski, M.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

C-5000 Issued in AR

Practice address

801 Scott St
Little Rock, AR 72201-4613

Phone

(501) 221-7238

Fax

(501) 221-7239

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

Yes

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 CA

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

Specialty

Psychiatry

Education

University of Arkansas College of Medicine, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Department of State Hospitals

  • Psychiatric Hospital
  • Coalinga, CA
  • NPI 1124078704
  Medicare reassignment Care Compare group NPD
• Department of State Hospitals

  • Psychiatric Hospital
  • Atascadero, CA
  • NPI 1174573802
  NPD
• Little Rock Community Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Little Rock, AR
  • NPI 1073685459
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1073661310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1433 KAVANAUGH BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722054323",
            "telephone_number": "501-221-7238",
            "fax_number": "501-221-7239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SCOTT ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722014613",
            "telephone_number": "501-221-7238",
            "fax_number": "501-221-7239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZENSKI",
        "first_name": "GREGORY",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AR",
            "license": "C-5000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104751001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Ann Justus, M.A., M.S.
• Margaret Justus, APN
• Jyrissa Robinson & Co LLC
• K & B Transportation LLC
• Alexander Scott Kaczenski, M.D.
• Michael Kaczkowski
• Bhadresh Kadakia, MD
• Mustafa Kadhim
• Brad Kaemmerling, MD
• Rebecca Kaeppel-Dieckmann, RN

• Clinical Neuropsychologist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Clinical Neuropsychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.