NPIMap

Individual provider Active NPI

Christopher Andrew Kennedy, PA-C

  • Physician Assistant
  • Scott Depot, WV
National Provider Identifier
1255317640
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
01012 Issued in WV
Practice address
300 Corporate Center Drive
Scott Depot, WV 25560
Phone
(304) 691-6800
Fax
(304) 691-6751
NPI assigned
Dec 19, 2005
Last updated
Dec 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 01012 WV Primary

Addresses

Primary practice location

300 Corporate Center Drive
Scott Depot, WV 25560

Mailing address

1249 15TH Street
Suite 4093
Huntington, WV 25701-3662
Phone (304) 691-6800

Other identifiers 1

IdentifierTypeStateIssuer
3810006501MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address christopher.kennedy@marshall.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071219000501 WV Practitioner - Physician Assistant 7416047063 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1249 15TH St
Suite 2000
Huntington, WV 25701-3662
Phone (304) 691-1000

1600 Medical Ctr Dr
Huntington, WV 25701-3655

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1012WVMDOccupational Therapist
01012WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians & Surgeons, Inc. CurrentSince Aug 28, 2017 Accepting new patients
University Physicians & Surgeons, Inc. CurrentSince Aug 28, 2017 Accepting new patients
New Century Emergency Physician of West Virginia Inc Physician Assistant Past Accepting new patients
Cabell Huntington Hospital Inc Past Accepting new patients

Locations

1249 15th St
Ste 4093
Huntington, WV 25701
Phone (304) 691-8714

1448 10th Ave
Ste 304
Huntington, WV 25701
Phone (304) 691-6381

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1255317640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 15TH STREET",
            "address_2": "SUITE 4093",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013662",
            "telephone_number": "304-691-6800",
            "fax_number": "304-691-6751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CORPORATE CENTER DRIVE",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "25560",
            "telephone_number": "304-691-6800",
            "fax_number": "304-691-6751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CHRISTOPHER",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006501",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "christopher.kennedy@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "300 Corporate Center Drive",
            "city": "Scott Depot",
            "state": "WV",
            "country_code": "US",
            "postal_code": "25560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Scott Depot, WV

Sources for this page

Verify at the official NPI Registry.