Christina Tan Michelle Kennedy, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003936AB Issued in IN

Practice address

6709 W Jefferson Blvd
Fort Wayne, IN 46804-6209

Phone

(260) 432-8409

Fax

(260) 484-0616

NPI assigned

Dec 7, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Group practices

C J Pataluch OD PCGroup PAC ID 8022207687, 4 clinicians

William a Argus MD PCGroup PAC ID 4284761222, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.78 of 100Reported as group

Quality

100

Improvement activities

40

Cost

79.25

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• C J Pataluch OD PC

  • Optometrist
  • Fort Wayne, IN
  • NPI 1760786503
  Medicare reassignment Care Compare group NPD
• William a Argus MD PC

  • Specialist
  • Fort Wayne, IN
  • NPI 1265755250
  Medicare reassignment Care Compare group NPD
• Frey Vision Group of Indiana Inc

  • Optometrist
  • Fort Wayne, IN
  • NPI 1699109256
  Medicare reassignment NPD
• Longe Enterprises Corp

  • Eyewear Supplier
  • Fort Wayne, IN
  • NPI 1083294532
  NPD (past)

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1154480911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 FRANKLIN TER",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044123",
            "telephone_number": "423-282-4221",
            "fax_number": "423-282-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6709 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046209",
            "telephone_number": "260-432-8409",
            "fax_number": "260-484-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CHRISTINA",
        "middle_name": "TAN MICHELLE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-07",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002409",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004315",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2916",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003936AB",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara M Kempf, PA
• Norman A Kempler, M.D.
• Edith L Kenna, MSW, LCSW
• Alison Louise Kennedy
• Amber Kennedy, BSN, RN
• Jin Jin Kennedy, RBT
• Judith L Kennedy, MD
• Shelby A. Kenner, MD
• Jasmine Kennerly, RN
• Kenneth a. Bundza and Sherwin Y. Kepes

• Optometrist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; 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.