Kenelm McCormick, M.D.

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

License

35058973 Issued in OH

Practice address

17876 Saint Clair Ave
Cleveland, OH 44110-2602

Phone

(216) 383-2222

Fax

(330) 722-5266

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Hospice of the Western Reserve at University Hospitals, LLC

  • Community Based Hospice Care Agency
  • Cleveland, OH
  • NPI 1821561614

  Family Medicine

  Medicare reassignment NPD
• Hospice of the Western Reserve, Inc.

  • Clinical Nurse Specialist
  • Cleveland, OH
  • NPI 1811163009
  Medicare reassignment
• Stein Hospice Services, Inc

  • Community Based Hospice Care Agency
  • Sandusky, OH
  • NPI 1811086374

  Family Medicine

  NPD
• Stein Hospice Services, Inc

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Sandusky, OH
  • NPI 1922334408
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512777600000",
    "number": "1205922895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17876 SAINT CLAIR AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441102602",
            "telephone_number": "216-383-2222",
            "fax_number": "330-722-5266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17876 SAINT CLAIR AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441102602",
            "telephone_number": "216-383-2222",
            "fax_number": "330-722-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "KENELM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2017-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35058973",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "OH",
            "license": "35058973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0824433",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000380130",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donisha McConnell
• Kelly McConnell, CNP
• Allison Stankus McConville, CNP
• Franchessca Dephia McCord Conway, HHA
• Kasey McCormack
• Mary Jo McCormick, RN
• Maureen McCormick
• Megan Ashley McCormick
• Sara McCormick, MA, MPH
• Jill B McCourt, CNP

• Hospice and Palliative Medicine (Family Medicine) Physician in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2017; 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.