Michael M Kennelly, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD00021678 Issued in WA

Practice address

16233 Sylvester Rd SW Ste 110
Burien, WA 98166-3044

Phone

(206) 901-8980

NPI assigned

Mar 17, 2006

Sex

Male

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WA

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

Interoperability endpoints

• Direct secure messaging: mkennelly58929@fhsce.catholichealth.net

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.

• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1023170313
  Medicare reassignment NPD
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463
  NPD
• Proliance Surgeons, Inc., P.S.

  • Orthopaedic Surgery Physician
  • Burien, WA
  • NPI 1538343033
  NPD

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1215996459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16233 SYLVESTER RD SW STE 110",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981663044",
            "telephone_number": "206-901-8980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16233 SYLVESTER RD SW STE 110",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981663044",
            "telephone_number": "206-901-8980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16233 Sylvester Rd SW Ste 110",
            "address_purpose": "LOCATION",
            "city": "Burien",
            "state": "WA",
            "postal_code": "981663044",
            "country_code": "US",
            "telephone_number": "206-901-8980",
            "fax_number": "206-901-8981",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16122 8th Ave SW",
            "address_2": "Suite D-1",
            "address_purpose": "LOCATION",
            "city": "Burien",
            "state": "WA",
            "postal_code": "981662967",
            "country_code": "US",
            "telephone_number": "206-244-1680",
            "fax_number": "206-243-8845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00021678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005224",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkennelly58929@fhsce.catholichealth.net",
            "affiliation": "N",
            "address_1": "16233 Sylvester Rd SW Ste 110",
            "city": "Burien",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981663044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkennelly58929@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "16233 Sylvester Rd SW Ste 110",
            "city": "Burien",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981663044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Scott C Kennard, M.D.
• Sandra J. Kennedy, A.R.N.P.
• Kennel and Kennel, PLLC
• Scott Kennel, D.D.S.
• Sofia Kennel, DDS
• Kenner and Kenner PLLC
• William Clinton Kenner V, DDS
• William Clinton Kenner IV, DDS
• Kent N. Kreisman, M.D.
• Pavithra Kesavan, M.D

• Surgery Physician in Burien, WA
• Providers in Burien, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.