NPIMap

Individual provider Active NPI

Kevin X McKennan, MD

  • Otology & Neurotology Physician
  • Sacramento, CA
National Provider Identifier
1356344022
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
G40176 Issued in CA
Practice address
1111 Exposition Blvd BLDG 700
Sacramento, CA 95815-4314
Phone
(916) 736-3408
Fax
(916) 233-4171
NPI assigned
May 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otology & Neurotology Physician 207YX0901X G40176 CA Primary

Addresses

Primary practice location

1111 Exposition Blvd BLDG 700
Sacramento, CA 95815-4314

Mailing address

1111 Exposition Blvd
BLDG 700
Sacramento, CA 95815-4300
Phone (916) 736-3399

Other identifiers 1

IdentifierTypeStateIssuer
040003543OtherCARR MEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20081223000221 CA Practitioner - Otolaryngology 2365511409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Albany Medical College of Union University, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1111 Exposition Blvd
Suite 700
Sacramento, CA 95815-4314
Phone (916) 736-3399

Hospital & facility affiliations

  • Mercy General Hospital Hospital, Sacramento, CA, CCN 050017
  • Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309
  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001
  • Sutter Amador Hospital Hospital, Jackson, CA, CCN 050014
  • Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108

Merit-based Incentive Payment System (MIPS)

Final score
74.25 of 100Reported as group
Quality
51.19
Promoting interoperability
94
Improvement activities
40
Cost
61.73

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sacramento Ear Nose & Throat Surgical & Medical Group Inc Otology & Neurotology CurrentSince Jul 1, 1987 Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Dignity Health Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

1111 Exposition Blvd
Bldg 700
Sacramento, CA 95815
Phone (916) 736-3399

1111 Exposition Blvd
Ste 700
Sacramento, CA 95815
Phone (916) 736-3399

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 6

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1356344022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD",
            "address_2": "BLDG 700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154300",
            "telephone_number": "916-736-3399",
            "fax_number": "916-233-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD BLDG 700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154314",
            "telephone_number": "916-736-3408",
            "fax_number": "916-233-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNAN",
        "first_name": "KEVIN",
        "middle_name": "X",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "CA",
            "license": "G40176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "040003543",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.