Individual provider Active NPI

Ryan Kenny, DO

  • Emergency Medicine Physician
  • Johnson City, NY
National Provider Identifier
1194139469
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
281229 Issued in NY
Practice address
33-57 Harrison St
Johnson City, NY 13790-2107
Phone
(607) 763-6412
NPI assigned
Jun 16, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 281229-1 NY
Student in an Organized Health Care Education/Training Program 390200000X 281229-1 NY
Emergency Medicine Physician 207P00000X 281229 NY Primary

Addresses

Primary practice location

33-57 Harrison St
Johnson City, NY 13790-2107

Mailing address

33 Lewis Rd
2ND FL
Binghamotn, NY 13905
Phone (607) 770-0025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, AK2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190924001334 NY Practitioner - Emergency Medicine 2264762905 Reassigns benefits to 1 organization
I20231122001738 AK Practitioner - Emergency Medicine 2264762905 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Norton Sound Health CorporationGroup PAC ID 7517858137, shared by 4 NPIs, 13 clinicians

Practice addresses (Care Compare)

1000 Greg Kruschek Ave
Nome, AK 99762-0966
Phone (907) 443-3311

Hospital & facility affiliations

  • Norton Sound Regional Hospital Hospital, Nome, AK, CCN 021308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
281229NYMDEmergency Medicine Physician
281229-1NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Sound Health Corporation CurrentSince Oct 1, 2023 Accepting new patients
United Medical Associates, P.C. CurrentSince Aug 12, 2019 Accepting new patients
Norton Sound Health Corporation Current Accepting new patients
United Medical Associates PC CurrentSince Aug 12, 2019 Accepting new patients
Norton Sound Health Corporation CurrentSince Oct 1, 2023 Accepting new patients

Locations

33 Lewis Rd
Fl 2
Binghamton, NY 13905
Phone (607) 729-8156

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1194139469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LEWIS RD",
            "address_2": "2ND FL",
            "city": "BINGHAMOTN",
            "state": "NY",
            "postal_code": "13905",
            "telephone_number": "607-770-0025",
            "fax_number": "607-271-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-57 HARRISON ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902107",
            "telephone_number": "607-763-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNY",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-16",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "281229-1",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "281229-1",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "281229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.