Individual provider Active NPI

Kate Ellen Kennedy

  • Nurse Practitioner
  • Bellevue, WA
National Provider Identifier
1245309442
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP30005602 Issued in WA
Practice address
1135 116TH Ave NE Ste 500
Bellevue, WA 98004-4627
Phone
(425) 635-6560
Fax
(425) 233-6292
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP30005602 WA Primary

Addresses

Primary practice location

1135 116TH Ave NE Ste 500
Bellevue, WA 98004-4627

Mailing address

1135 116TH Ave NE Ste 500
Bellevue, WA 98004-4627
Phone (425) 635-6560

Other identifiers 4

IdentifierTypeStateIssuer
1005867MedicaidWA
G8866114OtherWAMEDICARE PTAN
284940OtherINTERNAL ID-MOTOR VEHICLE ID
G8921537OtherWAMEDICARE PTAN

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070718000220 WA Practitioner - Nurse Practitioner 1052412251 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Overlake Medical Clinics LLCGroup PAC ID 7012808827, 423 clinicians

Practice addresses (Care Compare)

1135 116TH Ave NE
Suite 500
Bellevue, WA 98004-4627
Phone (425) 635-6560

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Overlake Medical Clinics, LLC Current Accepting new patients
King County Public Hospital District No. 2 CurrentSince Jun 1, 2023 Accepting new patients
King County Public Hospital District No 2 CurrentSince Jun 1, 2023 Accepting new patients
Overlake Medical Clinics LLC CurrentSince Mar 4, 2019 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients

Locations

1750 112th Ave NE
Ste B102
Bellevue, WA 98004
Phone (425) 688-5460

1135 116th Ave NE
Ste 500
Bellevue, WA 98004
Phone (425) 454-3938

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

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 3

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": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1245309442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE STE 500",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044627",
            "telephone_number": "425-635-6560",
            "fax_number": "425-233-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE STE 500",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044627",
            "telephone_number": "425-635-6560",
            "fax_number": "425-233-6292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "KATE",
        "middle_name": "ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30005602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005867",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G8866114",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "284940",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G8921537",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.