Active NPI
Bobby Joe Kennedy, DO
- Dermatology Physician
- Austin, TX
National Provider Identifier
1487766937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- E6115
- Practice address
- 6811 Austin Center Blvd
#300
Austin, TX 78731-3146 - Phone
- (512) 346-8888
- Fax
- (512) 344-0312
- NPI assigned
- Aug 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | E6115 | TX | Primary |
Addresses
Primary practice location
6811 Austin Center Blvd
#300
Austin, TX 78731-3146
Mailing address
PO Box 26726
Austin, TX 78755-0726
Phone (512) 407-8686
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 097806603 | Medicaid | TX | |
| 097806604 | Medicaid | TX | |
| CZ49 | Other | TX | BCBS |
| CZ49 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1487766937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26726",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787550726",
"telephone_number": "512-407-8686",
"fax_number": "512-406-6216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6811 AUSTIN CENTER BLVD",
"address_2": "#300",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787313146",
"telephone_number": "512-346-8888",
"fax_number": "512-344-0312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "BOBBY",
"middle_name": "JOE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "TX",
"license": "E6115",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "097806603",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "097806604",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "CZ49",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CZ49",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.