NPIMap

Individual provider Active NPI

Kennerly Clinton Patrick, D.O.

  • Nephrology Physician
  • Richmond, VA
National Provider Identifier
1346776507
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0102207203 Issued in VA
Practice address
1101 East Marshall St
Richmond, VA 23298
Phone
(804) 828-9682
Fax
(804) 828-7567
NPI assigned
May 10, 2017
Last updated
Aug 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 0102207203 VA
Nephrology Physician 207RN0300X 0102207203 VA Primary

Addresses

Primary practice location

1101 East Marshall St
Richmond, VA 23298

Mailing address

1101 East Marshall St. PO Box 980160
Richmond, VA 23298
Phone (804) 828-9682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20221129002226 VA Practitioner - Neurology 4880965508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

1001 E Leigh St
Richmond, VA 23298-5004
Phone (804) 828-7929

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.95 of 100Reported as group
Quality
69.91
Promoting interoperability
99
Improvement activities
40
Cost
77.42

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
MCV Associated Physicians CurrentSince Aug 9, 2022 Accepting new patients

Locations

1001 E Leigh St
Richmond, VA 23298
Phone (804) 628-7497

1101 E Marshall St
Richmond, VA 23298
Phone (804) 628-1925

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

1250 E Marshall St
#980509
Richmond, VA 23298
Phone (804) 489-7838

3470 Mayland Ct
Richmond, VA 23233
Phone (804) 527-4538

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

Organizations & group practices 1

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 7

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": "1494374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1346776507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 EAST MARSHALL ST. PO BOX 980160",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23298",
            "telephone_number": "804-828-9682",
            "fax_number": "804-828-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 EAST MARSHALL ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23298",
            "telephone_number": "804-828-9682",
            "fax_number": "804-828-7567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "KENNERLY",
        "middle_name": "CLINTON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-10",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102207203",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0102207203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.