Shaun Kennedy, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

59164 Issued in MN

Practice address

1575 Beam Ave
Maplewood, MN 55109-2502

Phone

(651) 232-7348

NPI assigned

Jun 26, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Emergency Medicine

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Highline Emergency Physicians PLLCGroup PAC ID 0547436313, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Highline Medical Center Hospital, Burien, WA, CCN 500011

Merit-based Incentive Payment System (MIPS)

Final score

82.72 of 100Reported as group

Quality

67.35

Improvement activities

40

Cost

85.26

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Highline Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Burien, WA
  • NPI 1669757290
  Medicare reassignment Care Compare group NPD
• Ecc Addiction & Toxicology Services LLC

  • Medical Toxicology (Emergency Medicine) Physician
  • Minneapolis, MN
  • NPI 1629532429
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Highline Medical Center

  • General Acute Care Hospital
  • Burien, WA
  • NPI 1558333682
  Care Compare affiliation

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407110265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 EAST 28TH ST MR 11112",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55407",
            "telephone_number": "612-863-6590",
            "fax_number": "612-863-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092502",
            "telephone_number": "651-232-7348"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St # Mc1102F",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-3666",
            "fax_number": "651-254-5216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHAUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "59164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly & Nguyen-Kelly Psychological and Consulting Services, LLC
• Alivia Catherine Kelly
• Amy Elizabeth Kelly, MD
• John F Kelly, MD
• Taylor Kenealy, PA-C
• Laura A Kenney, MSN, RN, ANP, CWOCN
• Andrew Joseph Keogh, DNP, APRN, CRNA
• Emily Christine Kerber, MS, CFY-SLP
• Kristen Marie Aggerbeck Kessler, M.D.
• Kong Khang, PHARMD

• Emergency Medicine Physician in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Emergency Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.