Active NPI
Michelle Kennedy, RSA
- Surgical Assistant
- Springfield, IL
National Provider Identifier
1104065713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- Practice address
- 1301 S Koke Mill Rd
Springfield, IL 62711-9252 - Phone
- (217) 547-9100
- NPI assigned
- Feb 5, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | |||
| Surgical Assistant | 246ZC0007X | Primary |
Addresses
Primary practice location
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Mailing address
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Phone (217) 547-9100
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650844800000",
"number": "1104065713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627119252",
"telephone_number": "217-547-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627119252",
"telephone_number": "217-547-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MICHELLE",
"credential": "RSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-05",
"last_updated": "2022-04-25",
"certification_date": "2022-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.