Individual provider Active NPI

Amanda R Grove-Kenney, AU.D.

  • Audiologist
  • Salem, OH
National Provider Identifier
1386651586
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
A01571 Issued in OH
Practice address
980 W State St.
Salem, OH 44460
Phone
(330) 726-3339
Fax
(330) 726-0482
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X A01571 OH Primary

Addresses

Primary practice location

980 W State St.
Salem, OH 44460

Mailing address

1032 Boardman Canfield Rd
#102
Youngstown, OH 44512
Phone (330) 726-3339

Other identifiers 3

IdentifierTypeStateIssuer
2097985MedicaidOH
000000503366OtherOHANTHEM
000000487075OtherOHANTHEM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070501000065 OH Practitioner - Qualified Audiologist 3678679123 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

980 W State St
Salem, OH 44460-2017
Phone (330) 337-3332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A01571OHMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Associates of Salem, Inc Audiologist CurrentSince Jan 1, 2010 Accepting new patients
Audiology Associates of Northeast Ohio Inc. Audiologist CurrentSince Jan 1, 2007 Accepting new patients

Locations

980 W State St
Salem, OH 44460
Phone (330) 337-3332

8309 High St NE
Warren, OH 44484
Phone (330) 394-3300

1032 Boardman Canfield Rd
Ste 102
Youngstown, OH 44512
Phone (330) 726-3339

126 York Ave
Youngstown, OH 44512
Phone (330) 726-3339

1400 S Raccoon Rd
Youngstown, OH 44515
Phone (330) 270-4327

3622 Belmont Ave
Youngstown, OH 44505
Phone (234) 719-1885

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1386651586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 BOARDMAN CANFIELD RD",
            "address_2": "#102",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "44512",
            "telephone_number": "330-726-3339",
            "fax_number": "330-726-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 W STATE ST.",
            "city": "SALEM",
            "state": "OH",
            "postal_code": "44460",
            "telephone_number": "330-726-3339",
            "fax_number": "330-726-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVE-KENNEY",
        "first_name": "AMANDA",
        "middle_name": "R",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OH",
            "license": "A01571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2097985",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000503366",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000487075",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.