Jeremy Scott Kennedy, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0102209089 Issued in VA

Practice address

611 Watkins Centre Pkwy Ste 350
Midlothian, VA 23114-4404

Phone

(804) 464-8644

Fax

(804) 464-8508

NPI assigned

Apr 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in AZ, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Dermatology

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Derm Associates LLCGroup PAC ID 4688653306, 44 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkennedy@usdp7.emadirect.md

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.

• Derm Associates LLC

  • Dermatology Physician
  • Silver Spring, MD
  • NPI 1649271354

  VA

  Medicare reassignment Care Compare group NPD
• Southwest Skin Specialists LLC

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1174521926
  Medicare reassignment NPD
• Southwest Skin Specialists, LLC

  • Clinical Medical Laboratory
  • Scottsdale, AZ
  • NPI 1609185347
  NPD

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1528022779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 WATKINS CENTRE PKWY STE 350",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231144404",
            "telephone_number": "804-464-8644",
            "fax_number": "804-464-8508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 WATKINS CENTRE PKWY STE 350",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231144404",
            "telephone_number": "804-464-8644",
            "fax_number": "804-464-8508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JEREMY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0102209089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9558781",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "4Z8735",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "707257",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01043135",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1528022779",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "707257",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "3437670",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alesha Nicol Kelley, COTA/L
• Ashley Redden Kelley, DPT
• Jason Kelley, PT, DPT
• Celeste Macdonald Kelly, PSYD
• James A Kelly, DDS
• Sara Kenney
• Glenn J. Kerr, M.D.
• Ketavia
• Muhammad Adnan Khan, DDS
• Shakil A Khan, M.D.

• Dermatology Physician in Midlothian, VA
• Providers in Midlothian, VA by specialty
• Dermatology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.