NPIMap

Individual provider Active NPI

Edwin Jeff Kennedy, M.D.

  • Orthopaedic Surgery Physician
  • Flowood, MS
National Provider Identifier
1457449589
Registry record updated Sep 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
10854 Issued in MS
Practice address
104 Burney Dr
Flowood, MS 39232-6621
Phone
(601) 987-8200
Fax
(607) 987-8211
NPI assigned
Oct 11, 2006
Last updated
Sep 8, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 10854 MS Primary

Addresses

Primary practice location

104 Burney Dr
Flowood, MS 39232-6621

Mailing address

PO Box 30594
Charlotte, NC 28230-0594
Phone (601) 987-8200

Other practice location 1

106 Highland Way Ste 102
Madison, MS 39110-6933
Phone (601) 987-8200

Other identifiers 1

IdentifierTypeStateIssuer
01031064MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040728001183 MS Practitioner - Orthopedic Surgery 9335128073 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Mississippi School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Orthopaedic Clinic, PLLCGroup PAC ID 0941215255, 49 clinicians

Practice addresses (Care Compare)

104 Burney Dr
Flowood, MS 39232-6621
Phone (601) 987-8200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.17 of 100Reported as group
Quality
82.12
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement43
Knee replacement104
Lower limb (leg) arthroscopy (minimally invasive joint repair)35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10854MSMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Orthopaedic Clinic PLLC CurrentSince Jan 1, 2006 Accepting new patients
Specialty Surgical Center, LLC Orthopaedic Surgery CurrentSince Sep 18, 2018 Accepting new patients
Capital Orthopaedic Clinic, PLLC Orthopaedic Surgery CurrentSince Jan 1, 2006 Accepting new patients
Kennedy White & Riggs Orthopedic Associates Orthopaedic Surgery Past Accepting new patients
Capital Orthopedic Clinic PLLC Orthopaedic Surgery Past Accepting new patients

Locations

745 Clinton Pkwy
Clinton, MS 39056

104 Burney Dr
Flowood, MS 39232
Phone (601) 987-8202

290 E Layfair Dr
#A
Flowood, MS 39232
Phone (601) 981-2825

106 Highland Way
Ste 102
Madison, MS 39110

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

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 8

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567900800000",
    "number": "1457449589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30594",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282300594",
            "telephone_number": "601-987-8200",
            "fax_number": "607-987-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 BURNEY DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392326621",
            "telephone_number": "601-987-8200",
            "fax_number": "607-987-8211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Highland Way Ste 102",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391106933",
            "country_code": "US",
            "telephone_number": "601-987-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "EDWIN",
        "middle_name": "JEFF",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2019-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MS",
            "license": "10854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01031064",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.