Warren K Kennedy, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

3420 Illinois St
Great Lakes, IL 60088-3120

Phone

(847) 688-2522

NPI assigned

Dec 24, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198454400000",
    "number": "1083898290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 ILLINOIS STREET",
            "city": "GREAT LAKES",
            "state": "ID",
            "postal_code": "600881312",
            "telephone_number": "847-688-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 ILLINOIS ST",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600883120",
            "telephone_number": "847-688-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "WARREN",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Lewis Jucovics, DDS
• Alex Kamenetsky
• Liam Richard Kastner
• Karen S Kato, OD
• Sherri Lynn Kenig
• Dorothy C Kent, MSN,PNP
• Jason Yungsup Kim, MD
• Min Kwan Kim, M.D.
• Bonnie J. Kimoto, R.D.
• Michelle Ann Klupp, RDH

• Medical Physician Assistant in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; 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.