Individual provider Active NPI

Nicholas Iung Kennedy, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Yakima, WA
National Provider Identifier
1285058545
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
MD61373829 Issued in WA
Practice address
111 S 11TH Ave
Yakima, WA 98902-3242
Phone
(509) 454-8888
Fax
(509) 453-0061
NPI assigned
Feb 6, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 64238 MN
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD61373829 WA Primary

Addresses

Primary practice location

111 S 11TH Ave
Yakima, WA 98902-3242

Mailing address

PO Box 5299
Ms: 820-5-Pco
Tacoma, WA 98415-0299

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230810004505 WA Practitioner - Orthopedic Surgery 8224300421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Oregon Health Sciences University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians

Practice addresses (Care Compare)

111 S 11TH Ave
Suite 320
Yakima, WA 98902-3273
Phone (509) 454-8888

Hospital & facility affiliations

  • Yakima Valley Memorial Hospital, Yakima, WA, CCN 500036

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement32
Lower limb (leg) arthroscopy (minimally invasive joint repair)17

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Memorial Physicians CurrentSince Aug 1, 2023 Accepting new patients
Yakima Valley Memorial Physicians Current Accepting new patients
Yakima Valley Memorial Physicians Orthopaedic Surgery CurrentSince Aug 1, 2023 Accepting new patients
Orthopedics Northwest PLLC Orthopaedic Surgery PastSince Jan 29, 2023 Accepting new patients

Locations

111 S 11th Ave
Ste 320
Yakima, WA 98902
Phone (509) 248-7184

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

111 S 11th Ave
Yakima, WA 98902
Phone (509) 248-2321

Interoperability endpoints

  • Direct secure messaging: nkennedy770697@direct.multicare.org

Organizations & group practices 4

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": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1285058545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5299",
            "address_2": "MS: 820-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023242",
            "telephone_number": "509-454-8888",
            "fax_number": "509-453-0061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "NICHOLAS",
        "middle_name": "IUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-06",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "64238",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "MD61373829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.