Active NPI
Shannon Renee Kennedy, M.D.
- Family Medicine Physician
- Onawa, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 38831
- Practice address
- 1614 Diamond Street PL
Onawa, IA 51040-1554 - Phone
- (712) 423-1525
- Fax
- (712) 423-2528
- NPI assigned
- Feb 17, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| 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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
Practice addresses (Care Compare)
1614 Diamond St PL
Onawa, IA 51040-1554
Phone (712) 423-1525
Hospital & facility affiliations
- Burgess Hospice
- Burgess Health Center
- Burgess Health Center
- Accura Healthcare of Onawa
- Pleasant View Care Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burgess Health Center | Current | Accepting new patients | |
| Burgess Health Center | Family Medicine | Current | Accepting new patients |
| Family Medicine Clinic, P.C. | Family Medicine | Current | Accepting new patients |
| Family Medicine Clinic, PC | Family Medicine | Current | Accepting new patients |
| Burgess Health Center | Current | Accepting new patients |
Locations
513 S Muckey St
Mapleton, IA 51034
Phone (712) 880-0222
1614 Diamond Street Pl
Onawa, IA 51040
Phone (712) 423-1525
1600 Diamond St
Onawa, IA 51040
Phone (712) 423-2311
Interoperability endpoints
- shannonkennedy@fmcc.allscriptsdirect.net
- shannonkennedy@bhcc.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.
| Facility | Type | Role | Since |
|---|---|---|---|
| Family Medicine Clinic, P.C. | 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.
-
- Family Medicine Physician
- Onawa, IA
- NPI 1063418820
General Partnership Interest
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 and National Provider Directory roles.
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Nursing Facility/Intermediate Care Facility
- Whiting, IA
- NPI 1649266842
Nursing home
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.