NPIMap

Individual provider Active NPI

Shannon Renee Kennedy, M.D.

  • Family Medicine Physician
  • Onawa, IA
National Provider Identifier
1497720197
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38831 Issued in IA
Practice address
1614 Diamond Street PL
Onawa, IA 51040-1554
Phone
(712) 423-1525
Fax
(712) 423-2528
NPI assigned
Feb 17, 2006
Last updated
Jan 24, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 38831 IA Primary

Addresses

Primary practice location

1614 Diamond Street PL
Onawa, IA 51040-1554

Mailing address

1614 Diamond Street PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20100830001105 IA Practitioner - Family Practice 7113041054 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Florida College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Medicine Clinic, P.C.Group PAC ID 0547159824, 10 clinicians

Practice addresses (Care Compare)

1614 Diamond St PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38831IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medicine Clinic, PC Family Medicine CurrentSince Sep 1, 2010 Accepting new patients
Family Medicine Clinic, P.C. Family Medicine CurrentSince Sep 1, 2010 Accepting new patients
Burgess Health Center Family Medicine CurrentSince Sep 1, 2010 Accepting new patients
Burgess Health Center CurrentSince Sep 1, 2010 Accepting new patients
Burgess Health Center Current Accepting new patients

Locations

513 S Muckey St
Mapleton, IA 51034
Phone (712) 880-0222

1600 Diamond St
Onawa, IA 51040
Phone (712) 423-2311

1614 Diamond Street Pl
Onawa, IA 51040
Phone (712) 423-1525

Interoperability endpoints

  • Direct secure messaging: shannonkennedy@bhcc.allscriptsdirect.net
  • Direct secure messaging: shannonkennedy@fmcc.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Medicine Clinic, P.C.Onawa, IA, CCN 163831 Rural health clinic General Partnership Interest (25%) Jun 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 5

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1497720197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHANNON",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "38831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Onawa, IA

Sources for this page

Verify at the official NPI Registry.