Active NPI
Kenneth J O'Neill, MD
- Internal Medicine Physician
- Stevensville, MI
National Provider Identifier
1447266341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301045698
- Practice address
- 5515 Cleveland Ave
Stevensville, MI 49127-9670 - Phone
- (269) 429-9644
- Fax
- (269) 429-4002
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301045698 | MI | Primary |
Addresses
Primary practice location
5515 Cleveland Ave
Stevensville, MI 49127-9670
Mailing address
5515 Cleveland Ave
Stevensville, MI 49127-9670
Phone (269) 429-9644
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110089876 | Other | MI | RAILROAD MEDICARE |
| 1101107081 | Other | MI | BLUE CROSS PIN |
| 2893924 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Niles Professional Services, Inc | Internal Medicine | Past | Accepting new patients |
| Southwestern Medical Clinic PC | Past | Accepting new patients |
Interoperability endpoints
- koneill3152@lakeland.midirect.net
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.
-
- Internal Medicine Physician
- Niles, MI
- NPI 1568407930
-
- Specialist
- Niles, MI
- NPI 1518022144
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1447266341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5515 CLEVELAND AVE",
"city": "STEVENSVILLE",
"state": "MI",
"postal_code": "491279670",
"telephone_number": "269-429-9644",
"fax_number": "269-429-4002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5515 CLEVELAND AVE",
"city": "STEVENSVILLE",
"state": "MI",
"postal_code": "491279670",
"telephone_number": "269-429-9644",
"fax_number": "269-429-4002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'NEILL",
"first_name": "KENNETH",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301045698",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110089876",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PIN",
"identifier": "1101107081",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2893924",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stevensville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.