Kimberly Kenehan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA055239 Issued in PA

Practice address

150 Mundy St
Mac IV Building
Wilkes Barre, PA 18702-6830

Phone

(570) 824-0930

Fax

(570) 824-7755

NPI assigned

Sep 29, 2011

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 identifiers 1

Other names 1

• Kimberly Peron Former name

Medicare fee-for-service enrollment

Enrolled in PA

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lackawanna Valley Dermatology Associates LimitedGroup PAC ID 2668459066, 18 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.11 of 100Reported as group

Quality

96.44

Promoting interoperability

100

Improvement activities

40

Cost

67.26

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: kkenehan@lackaderm.medentdirect.com

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.

• Lackawanna Valley Dermatology Associates Limited

  • Dermatology Physician
  • Scranton, PA
  • NPI 1982791117
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1317254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421107200000",
    "number": "1457635278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "address_2": "MAC IV BUILDING",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "address_2": "MAC IV BUILDING",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENEHAN",
        "first_name": "KIMBERLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-29",
        "last_updated": "2015-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA055239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50104798",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "PERON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannon Kemmerer, OT
• Kelly Ann Kempa, PHARMD
• Sabrina Kemper, PA-C
• Michael Kendra, PA-C
• Kristie Kendrick
• Jamie Leigh Kerestes, PHARMD
• Angela Ann Kern
• Patrick J Kerrigan, DO
• Edward John Kerwin, CRS
• Kabir Keshinro, MD

• Medical Physician Assistant in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; 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.