Cassandra Layne Kenny, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11056 Issued in TX

Practice address

2001 Rockview Dr
Granbury, TX 76049-5711

Phone

(682) 529-7800

NPI assigned

Jan 19, 2017

Last updated

Oct 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Cassandra Layne Petrilla Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ckenny@conger.emadirect.md
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Oliver Street 5.01(a) Inc.

  dba U.S. Dermatology Partners

  • Dermatology Physician
  • Dallas, TX
  • NPI 1457695413
  Medicare reassignment Care Compare group
• Cook Children's Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment NPD
• Concierge Dermatology Management, LLC

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1134615206
  Medicare reassignment
• Prestige Dermatology of Alliance, PLLC

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1427415314
  Medicare reassignment
• Prestige Dermatology PLLC

  • Dermatology Physician
  • Burleson, TX
  • NPI 1962878843
  Medicare reassignment
• Dermatology Associates

  • Dermatology Physician
  • Houston, TX
  • NPI 1356523039
  NPD (past)
• Wellworx Dermatology PLLC

  • Dermatology Physician
  • Frisco, TX
  • NPI 1164244703
  NPD (past)

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1386181048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 ROCKVIEW DR",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760495711",
            "telephone_number": "682-529-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1709 Martin Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Weatherford",
            "state": "TX",
            "postal_code": "76086",
            "country_code": "US",
            "telephone_number": "817-783-9973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNY",
        "first_name": "CASSANDRA",
        "middle_name": "LAYNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-19",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASSANDRA",
            "last_name": "PETRILLA",
            "middle_name": "LAYNE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suzanne M Kelley, APRN, FNP-C, WHNP-BC
• Kelli Virginia Kemp, SLP
• Laura Elizabeth Kemp, LCSW
• Bradley James Keneson, DO
• Jessica Kenney
• Moriah Kerr
• Lynda C Kersh
• Farzana Khan
• Tariq Ali Khan, MD
• Jennifer Lyn King

• Physician Assistant in Granbury, TX
• Providers in Granbury, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.