Individual provider Active NPI

Robert Jerome Kendell, D.O.

  • Facial Plastic Surgery Physician
  • Cadillac, MI
National Provider Identifier
1366417578
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
5101012647 Issued in MI
Practice address
8872 Professional Dr
Cadillac, MI 49601-8481
Phone
(231) 779-6260
Fax
(231) 779-6264
NPI assigned
Feb 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X 5101012647 MI Primary

Addresses

Primary practice location

8872 Professional Dr
Cadillac, MI 49601-8481

Mailing address

8872 Professional Dr
Cadillac, MI 49601-8482
Phone (231) 779-6260

Other identifiers 1

IdentifierTypeStateIssuer
4224164MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20110214000772 MI Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 5890975718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Robert Kendell D.O.,P.C.Group PAC ID 4981884806, 4 clinicians

Practice addresses (Care Compare)

8872 Professional Dr
Suite a
Cadillac, MI 49601-8482
Phone (231) 779-6260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision20
Removal or shaving of skin growth18
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Robert Kendell D.O.,P.C. Facial Plastic Surgery CurrentSince Jul 29, 2010 Accepting new patients
Lisa Jacobson D.O., P.C. Past Accepting new patients

Locations

8872 Professional Dr
Ste A
Cadillac, MI 49601
Phone (231) 775-9398

Organizations & group practices 3

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 2

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1366417578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8872 PROFESSIONAL DR",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496018482",
            "telephone_number": "231-779-6260",
            "fax_number": "231-779-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8872 PROFESSIONAL DR",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496018481",
            "telephone_number": "231-779-6260",
            "fax_number": "231-779-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDELL",
        "first_name": "ROBERT",
        "middle_name": "JEROME",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "MI",
            "license": "5101012647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4224164",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cadillac, MI

Sources for this page

Verify at the official NPI Registry.