NPIMap

Organization Active NPI

Colleen Kennedy DO PC

  • Family Medicine Physician
  • Rochester Hills, MI
National Provider Identifier
1295933000
Registry record updated Dec 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101012334 Issued in MI
Legal business name
COLLEEN KENNEDY DO PC
Practice address
75 Barclay Circle
Suite 225
Rochester Hills, MI 48307-4572
Phone
(248) 299-1892
Fax
(248) 299-1396
NPI assigned
Jul 3, 2007
Reactivated
Oct 6, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2010

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

Authorized official

Name
Mrs. Joanne S Goodrich
Title
Billing Supervisor
Phone
(248) 299-1892

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 5101012334 MI Primary

Addresses

Primary practice location

75 Barclay Circle
Suite 225
Rochester Hills, MI 48307-4572

Mailing address

75 Barclay Circle
Suite 225
Rochester Hills, MI 48307-4572
Phone (248) 299-1892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050222000431 MI Part B Supplier - Clinic/Group Practice 0042263808 Receives reassigned benefits from 3 practitioners
Practice locations: Rochester, MI

National Provider Directory

National Provider Directory

Locations

427 W University Dr
Rochester Hls, MI 48307
Phone (248) 299-1892

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1295933000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 BARCLAY CIRCLE",
            "address_2": "SUITE 225",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074572",
            "telephone_number": "248-299-1892",
            "fax_number": "248-299-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 BARCLAY CIRCLE",
            "address_2": "SUITE 225",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074572",
            "telephone_number": "248-299-1892",
            "fax_number": "248-299-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEEN KENNEDY DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2010-12-16",
        "deactivation_date": "2007-11-23",
        "reactivation_date": "2010-10-06",
        "status": "A",
        "authorized_official_last_name": "GOODRICH",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "248-299-1892",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101012334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.