Charles J Kennedy, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS015731 Issued in PA

Practice address

214 College Park PLZ
Johnstown, PA 15904-2833

Phone

(814) 262-0025

Fax

(814) 266-8745

NPI assigned

Jun 5, 2007

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nulton Diagnostic and Treatment Center, PCGroup PAC ID 5294621363, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Nulton Diagnostic & Treatment Center, PC

  • Neurodevelopmental Disabilities Physician
  • Johnstown, PA
  • NPI 1073573010
  Medicare reassignment Care Compare group NPD
• Nulton Diagnostic & Treatment Center, PC.

  • Community/Behavioral Health Agency
  • Johnstown, PA
  • NPI 1649515552
  NPD

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528260130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 COLLEGE PARK PLZ",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042833",
            "telephone_number": "814-262-0025",
            "fax_number": "814-266-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 COLLEGE PARK PLZ",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042833",
            "telephone_number": "814-262-0025",
            "fax_number": "814-266-8745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CHARLES",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS015731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1796076",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014900430001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynn Ann Keiper, PT
• Tai Keiper, RN
• Jennifer Keith, BSL, BCBA
• Faith Leeann Keller, OTR/L
• Sasha Kelley, LCSW
• Kenneth J. Kulback D.C.
• Patricia Ann Kerns
• Georgia Kerrick, CRNP
• Keystone Medicaid Eligibility Partners
• Keystone Rehabilitation Systems Inc (Keystone Physical Therapy)

• Clinical Psychologist in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.