Staci N Kenner, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

BPI0030889 Issued in TX

Practice address

95B-a, J.F. Harris Pkwy
Suite 102
Cartersville, GA 30120-2158

Phone

(770) 386-4824

Fax

(770) 386-4220

NPI assigned

Jul 1, 2008

Sex

Female

Sole proprietor

No

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 GA

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

Obstetrics/Gynecology

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cartersville OB-GYN Assoc PCGroup PAC ID 1355332685, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Cartersville Medical Center Hospital, Cartersville, GA, CCN 110030

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/Hn5sEtQzojwI35Jt9y2Zkrc_h-YSYc1T/

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.

• Cartersville OB-GYN Assoc PC

  • Obstetrics & Gynecology Physician
  • Cartersville, GA
  • NPI 1154378198
  Medicare reassignment Care Compare group NPD
• Cartersville Medical Center LLC

  • General Acute Care Hospital
  • Cartersville, GA
  • NPI 1780638833
  NPD (past)
• Women'S Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Cartersville, GA
  • NPI 1316276512
  NPD (past)

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

• Cartersville Medical Center LLC

  • General Acute Care Hospital
  • Cartersville, GA
  • NPI 1780638833
  Care Compare affiliation

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386892800000",
    "number": "1104088061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95B-A, J.F. HARRIS PKWY",
            "address_2": "SUITE 102",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301202158",
            "telephone_number": "770-386-4824",
            "fax_number": "770-386-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95B-A, J.F. HARRIS PKWY",
            "address_2": "SUITE 102",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301202158",
            "telephone_number": "770-386-4824",
            "fax_number": "770-386-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNER",
        "first_name": "STACI",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2013-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "BPI0030889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00312B113A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Kasper, NP-C
• Barbara Kay, PSYD
• Ralph Keene Jr., PHD
• Nancy Kelly, LPC
• Jordan Kemme, MD
• Kennestone Heart Physicians Group, PC
• Sackdinanh Nok Keomahathai, MD
• Michelle Khajavi, MS
• Amna Khan, LMSW
• Kidsz Paradise Inc.

• Obstetrics & Gynecology Physician in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; 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.